Fraser syndrome with limb reduction defect: a rare and unique anatomic variation.

INTRODUCTION: Fraser syndrome, named after George Fraser, is an autosomal recessive disorder showing a highly variable interfamilial phenotypic variation, with malformations ranging from minor symptoms to lethal anomalies like renal agenesis, incompatible with survival. Limb reduction defects have not been reported to be associated with it. CASE PRESENTATION: A 21-year-old primigravida presented to the antenatal outpatient department with a level two targeted anomaly scan report suggestive of severe oligohydramnios with suspected renal agenesis. The cranial vault bones were compressed, and orbital globes and lenses could not be visualized. Renal agenesis was confirmed due to sleeping adrenals sign, non-visualization of the urinary bladder, and Doppler of renal arteries. A detailed examination of the fetal head in the sagittal section showed the absence of an eye globe and lens, arousing suspicion of Fraser syndrome. After pregnancy termination, a complete fetal autopsy was done to look for any additional findings. CONCLUSION: Patients who have a syndromic mix of acrofacial and urogenital abnormalities with or without cryptophthalmos should be evaluated for Fraser syndrome, which can be diagnosed by clinical examination and perinatal autopsy.

Tri-ramification of left external carotid artery associated with anatomical variation of its branches and aneurysm formation.

Essential sources of arterial vascularisation in the head and neck region are the left and right common carotid arteries (CCA) and their branches. The left CCA (LCCA) originates from the arch of the aorta and the right CCA originates from the brachiocephalic trunk. In this case report, there was a bilateral higher division of CCA at the plane of the greater cornua of the hyoid bone, unilateral tri-ramification of the LCCA and the left external carotid artery (LECA), and the origin of the linguo-facial trunk and the pharyngo-occipital trunk from the LECA. An aneurysm formed in the distal part of LECA before its termination. In this case, we propose a novel categorization called the punnapatla classification for the anatomical variance branching forms of ECA. These kinds of variations are important to the surgeons, and anaesthetists, during the surgeries of the head and neck.

An anomalous pseudoganglion associated with high division of sciatic nerve.

Sciatic nerve (SN) is the thickest and longest nerve of the body. Deviations from the normal anatomical origin and level of bifurcation of SN have been frequently reported. In the present case, we are presenting a unique scenario of origin of terminal branches of the SN-tibial nerve (TN) and common peroneal nerve (CPN) in the pelvic region itself from divisions arising directly from the lumbosacral plexus. This variation was associated with origin of posterior femoral cutaneous nerve from the superior division of CPN with anomalous communicating branches between pudendal nerve and TN. The unique characteristics of the present case are the presence of 'pseudoganglion' found on the inferior division of TN. The present case stands out as the first of its kind to mention such pseudoganglion. Knowledge of some unusual findings like presence of pseudoganglion and intercommunications between nerves have clinical implications in anesthesiology, neurology, sports medicine, and surgery.

Anterolateral surgical triangle of the cavernous sinus: a cadaveric study of neurosurgical importance.

BACKGROUND: The anterolateral triangle around the cavernous sinus is a surgical skull base triangle used as a neurosurgical landmark essential to skull-based surgeries. There are few reports of its measurements with little attention paid to anatomical variations. METHODOLOGY: A total of 15 adult human cadaveric skulls were dissected to expose the anterolateral triangle on both sides. The triangle was defined and measurements of the three borders were taken precisely and the area of each triangle was calculated using Heron's formula. RESULTS: On an average, the length of the anteromedial border is 11.4 (+ 2.2 mm); the length of the posteromedial border is 8.7 (+ 2.6 mm); the length of the lateral border is 13.06 (+ 2.6 mm) and the area of the anterolateral triangle is 48.05 (+ 17.5 mm2). CONCLUSION: Concise understanding of anterolateral triangle is essential to skull-based surgeries; comprehending its anatomy helps with better surgical planning and provides insight into local pathology.

Vulnerabilities of Prostate Glandular Concretions Considered as Artefacts: A Cross-sectional Biopsy Slide Study.

Objective: There is no clear consensus regarding the contour of prostatic glandular intraluminal concretions. This study enlightens the rational approach toward deciphering the true nature of these concretions and evaluates their role in normal routine histology of the prostate gland. Methods: Fifty hematoxylin and eosin slides that were prepared from procured transrectal biopsy specimens of normal prostate glands from asymptomatic patients suspected of having a prostatic disease but later found to be normal were retrospectively observed for the staining, contour, and positioning of the aggregated masses or concretions within their prostatic lumina and were then compared with the blood prostate specific antigen (PSA) levels. Results: Although significant associations highlighting the utility of these masses in presumed pathological states of the gland were drawn by comparing their staining parameters and contours to those of their respective PSA levels, their interluminal contour variations and vivid staining appearances did not necessarily rule out the possibility of some of them being artefacts, provided they were assessed in totality with the surrounding acini. Intensely eosinophilic concretions were found in patients with a high mean age and those with high PSA levels. Conclusions: Prostatic intraluminal masses that were rounded tended to indicate pathological shifts within the gland; however, the possibility of them changing to artefacts during slide preparations could not be ruled out.

Unusual Pattern of Coeliac Trunk and Its Branches: A Cadaveric Study of Two Cases with its Embryological and Clinical Correlation.

The coeliac trunk, the first anterior branch, often originates at the level of the T12 vertebral body, right below the aortic hiatus, as the first ventral branch of the abdominal aorta. It commonly divides into the left gastric, common hepatic, and splenic arteries. We report a rare variation in the branching pattern and course of branches of the coeliac trunk in two donated female cadavers during routine abdominal dissection. It is essential to understand the coeliac trunk and the distinctions in its origin and branching pattern to perform efficient upper abdominal surgical and radiological procedures and to adopt novel interventional and treatment options for hepatic cancers. As anatomists, we are also attempting to link our study's variations to their embryological genesis.

Azygos anterior cerebral artery associated with hypoplastic A1 fragment of right anterior cerebral artery.

Anterior cerebral arteries are paired and supply the major portion of the medial surface of the brain. They are branches of the intracranial part of the internal carotid artery and form the anterior portion of the circle of Willis (CW) which is situated in the interpeduncular fossa. During routine dissection in the department of anatomy, All India Institute of Medical Sciences, Bibinagar, Hyderabad, a rare variation had been observed in the CW, azygos anterior cerebral artery associated with hypoplastic A1 fragment of the right anterior cerebral artery in a 63-year-old female cadaver. It is important to identify and study this kind of rare variation for surgeons, anatomists, and radiologists during dissection, surgical, radiological, and diagnostic interventions.

A study on the congruence and proximity of the sling and clasp fibres at the cardio-esophageal junction of the stomach.

BACKGROUND AND AIM: The cardio-oesophageal sphincter that is located in close longitudinal proximity to the origin of the lesser curvature of the stomach has a unique pattern of external muscle fibres whose inner oblique layer would normally form an elongated sling and the middle partially circular layer would form a projecting clasp into the already existing muscular sling of the former congruently, which would result in the formation of an anatomical sphincter in that area that would normally be devoid of the external longitudinal muscle layer coat. Certain authors have disagreed with the notion of this standard literature and have proposed that the clasp and sling fibres need not necessarily be congruent and may even remain independent of each other with partial contributions from the longitudinal muscle layers as well that may arise tangentially in different populations, which may in turn contribute to reflux oesophagitis in that population. Hence, the clasp and sling fibre muscular patterns were observed in six formalin-embalmed cadavers at the department of anatomy in a tertiary care institute as part of routine dissections in series, and the findings were then reported. FINDINGS: At the junction of the lesser curvature of the stomach with the oesophagus, all six cadavers showed a longitudinal sling pattern as opposed to the conventional oblique sling. The circular muscle layer was found to be merged with the outer longitudinal muscle layer to form the sling that pulled away from the clasp, resulting in a loss of congruency for the same. The clasp fibres, however, were found to be contributed by the inner oblique muscle layer. The conventional perpendicular or tangential merging of the clasp with the sling was not observed; instead, an obtuse, blunt angular merging of the clasp with the sling was observed. DISCUSSION: The deviation of the sling from the clasp could indicate a lack of a proper fit between them at the cardio-oesophageal sphincter. The lack of robustness in the attachment of the clasp to the sling may possibly contribute to the diminished taut pull of the clasp in this subset of the population. These would be significant determinants for a predisposition to reflux oesophagitis and Barrett's oesophagus.

Anatomical variation of quadratus plantae in relation with flexor digitorum brevis.

The muscles of the sole have been traditionally categorized into four layers, but it is more practical to divide them into peripheral and central groups. The peripheral groups include medial and lateral groups. The central plantar muscles are more numerous and divided into superficial and deep layers. During routine dissection in the Department of Anatomy, All India Institute of Medical Sciences Bibinagar, Hyderabad, variations are been observed in the plantar intrinsic muscle in the left foot & right foot of a 53-year-old male cadaver. This is the first cadaveric report of a combination of discrepancies especially the inter-tendinous connection between quadratus plantae and flexor digitorum brevis. Similar observations in the literature were not found by us. It is important to identify and study these dissimilarities of muscles of the sole for surgeons, anatomists, radiologists and orthopaedics as these muscles and tendons are used in foot reconstructive procedures, and for the treatment of some congenital anomalies.

Importance of online self-assisted assessments for medical students in knowledge acquisition.

BACKGROUND: Assessment is an important aspect of teaching and learning in medical education. Regular early assessments create scope for improvement in students, and this digital era technology should be utilized for ease of administration. E-assessment involves the usage of technology to create, deliver, collect, and provide feedback to the students. The present study aims to understand the importance of online assessment and the preference of students with difficulties faced and the methods of improvement. METHODS AND MATERIALS: This study was a cross-sectional descriptive study conducted among fifty-six undergraduate medical students, where forty-five objective structured practical questions (OSPEs) were administered to the students in anatomy. After the assessment, feedback was collected in the form of a fifteen-item questionnaire. The responses were graded using a five-point Likert scale and represented in the graphs using Microsoft Excel software. RESULTS: The feedback collected has the following responses. The prosected specimen pictures used in the exam, with pointers and markers, were clear and oriented for which 77% agreed, the pointers and markers were clear and easy to identify for which 79% agreed, and 66% preferred the traditional method of assessment over the online mode of assessment and 48% were neutral on the question of whether E-assessment improves knowledge and skills. Most of the students preferred the traditional method of assessment over the online method of assessment. CONCLUSIONS: Traditional methods of teaching or assessment cannot be replaced by online methods, but technology can be utilized as an addition to regular mode to improve the outcome. Regular early formative assessments help teachers to understand areas of deficiency and help students in improvement. E-assessment can be adapted for formative assessment and regular practice because of their ease of administering and providing feedback simultaneously.

Innovative Cadaver Preservation Techniques: a Systematic Review.

Cadaveric dissection is a unique and unrivalled educational tool that allows students in medicine and associated life sciences to explore spatial three-dimensional anatomy, principles of structure and related function, and anatomical variations, including pathological alterations. Human tissue dissection enables researchers to comprehend the variety that exists in life that cannot be appreciated through the literature or artificial specimens. Using cadavers is the best way to simulate surgical and anatomical teaching. A cadaver has been shown to imitate surgical and anatomical training better than any other existing method. By the use of soft embalming approaches, cadavers have become more realistic and training-friendly. The main aim of this review is to describe various innovative and recent cadaver preservation techniques in detail, which can help anatomists to modify the techniques in their institute for gross anatomy teaching and surgical training or workshops to get a lifelike cadaver.

A Rare Variation of Plantar Interossei Muscles of the Foot - a Case Report.

The variations in the attachment of plantar interossei might affect the gait of the individual and also raise questions about the function of this muscle at the tarsometatarsal joints. During routine dissection of the right lower limb, we encountered a unique variation in the attachment of plantar interossei. The first plantar interossei took origin from the lateral side of the base of the first metatarsal and inserted into the lateral side of the base of the proximal phalanx of the great toe. The second and third plantar interossei took origin from the medial surface of the base of the second and third metatarsals, respectively, and inserted into the medial side of the base of the proximal phalanges of the corresponding digits. The third and fourth intermetatarsal spaces were void, indicating the absence of these muscles from those spaces. The clinical significance of this variation has been discussed.

A Rare Variation of High Division of the Sciatic Nerve and Associated Neuromuscular Variations in the Gluteal Region.

Variations in the anatomical division of the sciatic nerve are not uncommon. In this case report, we are presenting a rare variation of the sciatic nerve in relation to the superior gemellus and the presence of anomalous muscle. To the best of our knowledge, the anomalous communicating branches of the posterior cutaneous femoral nerve with tibial and common peroneal nerve and the presence of an anomalous muscle originating from the greater sciatic notch and inserting at ischial tuberosity have not been reported yet in the literature. This anomalous muscle found can be named as 'Sciaticotuberosus' after its origin and insertion. Such variations hold clinical significance as they may contribute to piriformis syndrome, coccydynia, non-discogenic sciatica, and popliteal fossa block failure leading to local anesthesia toxicity and blood vessel traumatization. The current classifications of division of the sciatic nerve are based on its relation to the piriformis muscle. In our case report, the variation of the sciatic nerve in relation to the superior gemellus suggests the need for the revision of current classification systems. Category-like division of the sciatic nerve in relation to the superior gemellus muscle can be added.

Arteria lusoria with patent foramen ovale: clinical and embryological significance with literature review.

A 73-year-old female donated cadaver had an unusual origin of the right subclavian artery (RSA), which is usually known as 'Arteria lusoria' (AL) or "Aberrant Right Subclavian Artery" (ARSA). This artery originated as the fourth and most extreme left branch from the arch of the aorta (AOA), distal to the origin of the left subclavian artery (LSA), and traversed obliquely upwards, towards the right side posterior to the oesophagus, heading for the thoracic inlet. The brachiocephalic trunk (BCT) was absent. The right common carotid (RCCA), left common carotid (LCCA), LSA and ARSA were four branches that originated from the aortic arch and ran from right to left. The course and distribution of these branches were normal. On opening the right atrium, a patent foramen ovale (PFO) was observed in the upper part of the interatrial septum. As far as we know, this is the first cadaveric case report of arteria lusoria with the presence of an atrial septal defect in the form of a PFO. Early diagnosis of aortic arch abnormalities using diagnostic interventions is beneficial for identifying risk factors after invasive procedures.

Unilateral accessory brachialis muscle and its functional significance: a case report of rare variation.

Variations of the brachialis muscle are uncommon in the literature. During regular cadaveric dissection, we observed the unilateral presence of an accessory muscle in the front of the right arm of a female cadaver, taking its origin from the medial aspect of the brachialis and the adjacent intermuscular septum. The muscle belly descended downwards, crossed the neurovascular bundle in the cubital fossa and merged with the fibres of the pronator teres. There is no doubt regarding its significance in the etiogenesis of numerous compression syndromes due to its close topographical relationship with the neurovascular bundle. In our report, we consider the potential developmental process and therapeutic implications of this variation, which can aid surgeons in their strategy and management.

An accessory muscle of flexor digitorum profundus with bipennate first lumbrical: a unique variation of clinical significance.

During the deep dissection of the front of the forearm, an anomalous accessory muscle in relation to the flexor digitorum profundus (FDP) muscle was observed in the right forearm. The accessory muscle consisted of a spindle-shaped muscle belly with a long tendon underneath the flexor pollicis longus muscle. When followed distally, the accessory muscle tendon was found lateral to the FDP tendon for the index finger and entered the palm deep to the flexor retinaculum. In the palm, we encountered the first lumbrical muscle as a bipennate muscle taking origin from the adjacent sides of the middle of the tendons of FDP and accessory muscle tendon. After giving origin to first lumbrical muscle, the accessory muscle got merged with the tendon of FDP for index finger. Understanding this kind of variation is required for radiologists and hand surgeons for diagnostic purposes and while performing corrective surgical procedures.

Anatomy acts concerning body and organ donations across the globe: past, present and future with a special emphasis on the indian scenario.

From the era of pre-historic times, the ancient Indians and the Greeks highlighted the importance of body and organ donations thereby emphasizing the need for anatomical sciences in medicine through the use of effective dissections for the same. However, after the Renaissance, there was a surge in dissections throughout the world, particularly in Europe, as a result of which various laws were enacted by governments concerning the procurement of bodies for the purpose of scientific dissections, which were later promulgated throughout the world through various anatomical acts. The situation in India was quite similar to that of Britain until its independence in 1947, after which different Indian states formulated their own anatomy acts that had their own merits and pitfalls. Hence, this literature review serves to highlight the various acts throughout history and would serve as a guide to emphasize the future perspectives of formulating a centralized unified anatomy act for the Indian nation that could possibly be the need of the hour.

Variant pectoralis minor muscle: a case study with clinical relevance.

The pectoralis minor (PMn) muscle originates from the third, fourth, and fifth ribs near the costochondral junctionusually and gets inserted on the medial margin and upper surface of the coracoid process of the scapula. To look at the morphological insertion patterns and sites of attachment of the PMn muscle in the donated cadavers. Over all 19 limbs were included in the study (9 right and 10 left). Out of 19 limbs, 10 belonged to female and 9 belonged to male cadavers. The cadavers were meticulously dissected to determine the morphological insertion types and location of the attachment of the muscle. Unusual pattern of insertion was observed in 6 limbs (31.6%) out of total 19 limbs included in the study. The variations we observed does not fall completely in the classification by Le Double, hence variations we observed can be considered as new and rare variant which to our knowledge is not reported in literature. We propose this new variant to be type 4 of Le Double classification. The potential of ectopic PMn tendon should be taken into consideration and tested out, especially in patients with shoulder discomfort and stiffening who have ruled out the more frequent diseases. For proper surgical planning, a preoperative magnetic resonance imaging or USG examination of the shoulder joint is required considering the prevalence of variation in the insertion pattern of PMn muscle. Preoperative identification of any abnormal PMn insertion can help to reduce the risk of iatrogenic tendon injury and post-operative problems.

Student Team Achievement Division as a tool for peer assisted co-operative learning in neuroanatomy.

Student Team Achievement Division (STAD) is a co-operative learning approach premised on a group learning activity that emphazises learning as a social exchange of knowledge between students, in which each student is accountable for his or her own learning and is also encouraged to assist others in achieving their goals. It promotes the cognitive, psychomotor, and emotional growth of students involved in the team. By random sequencing, 60 participants were allocated to interventional group (n=30) and control group (n=30). The participants of the interventional group were subjected to STAD strategy and participants of the control group were instructed to do a conventional self learning on the ventricles of brain. The outcomes were statistically analysed. It was found that the performance of the students is far better with STAD approach than conventional self learning. Our study has shown that Students team Achievement Division can be used as an effective tool for Peer assisted Co-operative Learning in Anatomy. Further studies can be done to investigate the contribution of STAD to teaching other disciplines of Anatomy and other basic medical sciences.

Morphologic Variation of Liver Associated With Hourglass Stomach: Case Report and Literature Review.

Ectopic liver tissue is a rare developmental abnormality, and its association with hourglass constriction of the stomach is undocumented to date. This case report describes the discovery of morphologic variations in the liver of an adult female cadaver during routine dissection. The variations include a small, pedunculated, club-shaped accessory lobe covered by a glistening fibrous capsule connecting it to the gallbladder wall, with vessels radiating into the lobe. Two additional lobes were present, one attached to the right upper margin of the caudate lobe, overlapping the inferior vena cava, and another near the quadrate lobe. The right lobe had an abnormal shape with multiple incomplete fissures and furrows. The left lobe was hypoplastic with an elongated end, resembling a lingular process. Further dissection revealed a prominent fibrous band on the posterior surface of the stomach, which continued anteriorly, giving it an hourglass appearance. Knowledge of such variations helps surgeons and radiologists rule out related abnormalities.