Anatomical variation of the Dorsalis pedis artery in a South African population - A Cadaveric Study.

BACKGROUND: The dorsalis pedis artery is responsible for blood supply to the dorsal aspect of the foot and is vital in the clinical assessment of the arterial supply thereof. Clinical assessment should consider anatomical variations of dorsalis pedis artery. Clearly, a thorough understanding of the potential variations of the vasculature in the area is important for a precise clinical assessment of arterial supply to the foot. The aim of this study was to investigate the different branching patterns of the dorsalis pedis artery that exist in a South African population. METHODS: A Cadaveric study in which a total of 33 dissected lower limbs (27 adult cadavers and 6 partial wet lower limb specimens) of a South African population sample were studied. The course and branching pattern of the dorsalis pedis artery were photographed and documented. RESULTS: Nine variations of the dorsalis pedis artery were recorded, with the standard branching pattern being the most common with an incidence of 36.36% and a completely absent dorsalis pedis artery variation was noted in 6.06% of the sample. CONCLUSION: Nine variations of the arterial anatomy of the dorsalis pedis artery were identified in this current study. Each of these may possibly alter the location or strength of the dorsalis pedis pulse affecting clinical assessment outcomes. Knowledge of dorsalis pedis variations may be useful to clinicians when making clinical decisions.

Ectopic adrenocorticotropic hormone syndrome in a case of duodenal neuroendocrine tumor presenting with liver metastasis.

Ectopic adrenocorticotropic hormone (ACTH) syndrome is an uncommon disorder and comprises about 15% of all patients with Cushing's syndrome (CS). Duodenal carcinoids are rare, indolent tumors usually associated with a benign progression. We hereby report a rare case of CS resulting from ectopic ACTH secretion from a duodenal neuroendocrine tumor (NET) presenting with liver metastasis. A 37-year-old female presented with abdominal discomfort and dyspepsia of 1-month duration. Ultrasound abdomen suggested a well-defined hypoechoic lesion in the left lobe of the liver, suggestive of neoplasia. On clinical examination, she had Cushingoid features and persistent hypokalemia. Midnight ACTH and cortisol levels were grossly elevated at 1027 pg/ml (n < 46 pg/ml) and 87.56 µg/dl (n < 7.5 µg/ml), respectively. Both overnight and high-dose dexamethasone suppression test confirmed nonsuppressed cortisol levels - 86.04 and 84.42 µg/dl (n < 1.8 µg/ml), respectively. Magnetic resonance imaging brain showed a structurally normal pituitary gland. Computed tomography scan of the abdomen revealed hepatic lesion with bilateral adrenal enlargement. A diagnosis of ectopic ACTH-dependent CS was made. Intraoperatively, a duodenal lesion of 0.5 cm × 0.5 cm was identified alongside an 8 cm × 6 cm exophytic lesion in segment IV of the liver. Frozen section of the duodenal lesion was positive for NET. She underwent a Whipple's surgery, cholecystectomy, and left hepatic lobectomy. Postoperatively, she showed clinical and biochemical remission. Herewith, we report the third case of duodenal carcinoid tumor presenting as ectopic ACTH syndrome and the first with liver metastasis.

Incidence of the coracoclavicular joint in South African populations.

The presence of a diarthrotic coracoclavicular joint, as represented by an articular facet on the conoid tubercle of the clavicle and the superior surface of the coracoid process of the scapula, was investigated. The sample consisted of 60 white and 180 black South African (60 Sotho, 60 Xhosa and 60 Zulu) skeletons. Each group consisted of 30 male and 30 female skeletons. The presence of the articular facet was recorded as either bilateral, unilateral left or unilateral right. The effect of clavicular length, scapular size and first rib angle on the presence of the coracoclavicular joint was also investigated. The presence of the articular facet was noted in 23 (9.6%) of the 240 individuals studied. Of these 23 individuals, 6 (26.1%) were white and 17 (73.9%) were black. Males (56.5%) presented a higher incidence of this anomaly than females (43.5%). The articular facet occurred bilaterally in 47.9% (11/23), unilaterally on the left in 30.4% (7/23) and unilaterally on the right in 21.7% (5/23). Sexual, racial and tribal differences were not statistically significant. Individuals possessing the joint showed statistically significantly (P < 0.01) larger scapulae (increased border lengths and superior angles), longer clavicles and longer first ribs. No statistically significant differences in the first rib angles were observed between individuals who possessed the joint and those who did not, thus implying similar thoracic inlet size. It is proposed that the aforementioned morphometry of the scapulae, clavicles and first ribs may restrict associated movements of the scapulae, resulting in the development of the coracoclavicular joint.