Liver morphology: anatomical study about the outer aspects.

PURPOSE: Hepatobilliary surgery is nowadays increasingly done throughout the world with advent of newer liver imaging modalities. Considering recent interest for accurate interpretation of different radiological images and performing surgical procedures, a precise understanding of hepatic surface anatomy is challenging due to high prevalence of previously identified morphological variations. Accordingly, a cadaveric study was attempted to revisit the morphological details of liver updating the unusual configurations along with their clinico-anatomical correlations and thus, compare the analysis of present study with previous published data. METHODS: We studied 110 formalin-fixed adult cadaveric livers of unknown age and sex having no pathological lesion or damage. RESULTS: More than one morphological variation in combination was observed on repeated occasions in same liver specimen. The anatomical classification based on Netter's criteria was chosen in order to be coherent with previous studies to define different variations with addition of other subtypes. Accordingly, classical wedgeshaped livers were present in 57.3% specimens. Considering different morphological features, 78 (70.9%) variant livers were noted in terms of shape (as transverse saddle shaped, square shaped, globular, quadrilateral, pyriform or boot-shaped), altered numbers and position of fissures (affecting either one or more lobe in addition to absent fissure for ligamentum teres) or lobes (as aplasia, hypoplasia or hypertrophy) or processes (in addition to abnormalities of processes extending from caudate or quadrate lobe tongue-like process or appendix fibrosa hepatis or mini-accessory lobe) or impressions (as costal or variant visceral impressions affecting inferior surface) or evidence of pons hepatis(35.5%) orin combinations of all above. CONCLUSION: Awareness of hepatic surface variation is worth knowing in successful planning of hepatobilliary surgeries with least complications.

Comprehensive study of pulmonary hilam with its clinical correlation.

INTRODUCTION: Awareness of pulmonary hilar variations is essential for lobectomy of lung. MATERIALS AND METHODS: We studied 54 left and 49 right hilum of formalin fixed adult cadaveric lungs. Morphologic and mophometric details were recorded and variations were noted. RESULTS: Classical picture of hilum was found in 35.19% left lung and 40.82% right lung. Morphological variations were more on left side (64.81%) than right side (59.18%) in terms of numbers of structures. On the left side, highest percentage of variable structure was bronchus (46.3%) followed by pulmonary artery (37.31%) and lowest by pulmonary vein (31.48%) whereas on right side, percentage for variable pulmonary artery and vein were same (36.73%) followed by bronchi (20.41%). Maximum number of pulmonary veins was five, pulmonary artery was three and accessory bronchus was two on both side hila. In morphometric measurement, mean vertical length of hilum was more on right side whereas anteroposterior length was more on left side. Right hilum is slightly lower and anteriorly placed than left hilum in the mediastinal surface of lung. Significant correlations between vertical length of lung and hilum and antero-postero length of lung and hilum of left and right sides were found. CONCLUSIONS: By analysis and comparison with previous studies, present study concludes that morphology of pulmonary hila is extremely variable which contributes significant consequences in the field of pulmonary resection.

Papillary muscles of left ventricle-Morphological variations and it's clinical relevance.

INTRODUCTION: The two left ventricular papillary muscles are small structures at sternocostal and inferior wall but are vital to mitral valve competence. Extra papillary muscles could be found. Partial or complete rupture, complicating acute myocardial infarction, causes severe or even catastrophic mitral regurgitation, potentially correctable by surgery. Detailed knowledge of normal anatomy and variations is vital for accurate interpretation of information by echocardiography and for surgical repair. MATERIALS AND METHODS: The material for present study consisted of 52 formalin fixed adult apparently normal cadaveric hearts belonging to either sex obtained from the Department of Anatomy. These hearts were dissected carefully to open the left ventricle and to expose the papillary muscles. According to their attitudinal position they were described as supero-lateral (S-L) and inferoseptal muscle (I-S) instead of conventional anterolateral and posteromedial. Different morphological features of papillary muscles were noted and measurements were taken. RESULTS: Classical picture of left ventricular papillary muscle was found only in 25% cases. Additionally extra muscles were found 34.61% and 71.15% in S-L and I-S group, respectively. Different shapes and pattern of papillary muscles were also been identified. An additional attribute of this study was measurement of length and breadth of papillary muscles which thus provides a base line data for further detailed studies in a large scale. CONCLUSION: Oriental nomenclature is necessary not only for anatomist but also for electrocardiographers. Breadth of papillay muscle should be taken into morphometric account as for screening of hypertrophic cardiomyopathy. Proper anatomical knowledge is crucial for clinicians, surgeons and radiologists.

Papillary muscles of right ventricle-morphological variations and its clinical relevance.

INTRODUCTION: Papillary muscle plays an important role in stabilizing the position of the tricuspid valve. Several pathologies can result in anatomical and functional abnormalities of the papillary muscles. The aim of the study is to deliberate the morphometry of papillary muscles in tricuspid valve and to analyze with the eminent research works previously done. MATERIALS AND METHODS: The study was carried out in 52 formalin-fixed adult apparently normal cadaveric hearts belonging to either sex obtained from the Department of Anatomy. These hearts were dissected carefully to open the right ventricle and to expose the papillary muscles. Different morphological features of papillary muscles were noted, and measurements were taken. RESULT: The classical picture of three papillary muscles existed in 23.07% of the specimens. Anterior papillary muscle was in all hearts, but posterior and septal muscle was off in 15.38% and 55.76%, respectively. Double and triple papillary muscles were seen too. Anterior and posterior muscle appeared predominantly flat-top and arose from the middle third (mostly), while septal muscle was chiefly conical and originated basically from the upper third of the ventricular wall. Chordopapillary relationship with tricuspid valve leaflets was beyond conventional. Mean length and breadth of anterior muscle were 2.19±0.59 cm and 0.76±0.26 cm, those of posterior muscle were 1.39±0.63 cm and 0.67±0.43 cm, and those of septal papillary muscle were 0.95±0.38 cm and 0.59±0.09 cm. CONCLUSIONS: Detailed knowledge of normal and variable anatomy of papillary muscles is not only necessary for better understanding of tricuspid pathologies but also valuable for successful newer surgical approaches in cardiac treatment.

Body Donation after Death: The Mental Setup of Educated People.

INTRODUCTION: Without dissection of cadavers teaching and learning of anatomy is nearly difficult; there remains a gap between the practical knowledge and the gathered theoretical knowledge. But there is a scarcity in the availability of the donated bodies for the sake of medical education. On the other hand a large number of people in our country are in waiting list for organ transplantation which could be overcome by deceased organ donation. AIM: Aim of the study was to evaluate the awareness regarding body donation after death. MATERIALS AND METHODS: A cross-sectional study was conducted among medical students, engineering students and doctors in Indian population. Total 300 participants were answered the questionnaire providing information about the knowledge and attitude towards body and organ donation. RESULT: 46.33% of entire study group had strongly positive attitude about cadaveric organ donation and 17% had no idea about this. 18% of total participants were unwilling for body donation after death. CONCLUSION: The present study has been done elaborately to find out the different barriers for body or organ donation. It is clear from the study that though there is high level of awareness, nobody has filled up the pledge form till now. It indicates that there is a gap between the knowledge and motivation for organ and body donation after death which has to be overcome by proper guidance and education. Media and other voluntary organisations could take an important role for this purpose.

A cadaveric study of bilateral configuration of posterior bifurcation of posterior communicating artery in Indian population.

INTRODUCTION: Various studies have been done regarding variations of circle of Willis, but few literatures are available about the detail configurations on Indian population. Posterior communicating artery is the main collateral channel between the vertebrobasilar and carotid system. It may act as a main source of blood flow via posterior cerebral artery if fetal configuration is present. Aim of the study is to see the bilateral configurations to compare the blood supply of both cerebral hemispheres via posterior cerebral artery in human cadavers. MATERIALS AND METHODS: Fifty six formalin fixed brains were used for study. The specimens were classified into 3 types and 21 subtypes according to the configuration of the vessel of both hemispheres. As hemodynamic balance is dependent on the calibre of the vessel, the diameter of the arteries were also taken into consideration. Pearson's correlation had been done. RESULT: In present study type I is 57.2%, type II is 37.5% and type III is 5.4%. Incidence of unilateral fetal type posterior cerebral artery is in high percentage (33.9%). Greatest diameter of posterior communicating artery is 3.8mm on right and 3.6mm on left side. Significant correlations also have been found between arterial segments of different types. CONCLUSION: It is expected that the study will help to enrich the knowledge about the arterial predominance of origin of posterior cerebral artery of both cerebral hemispheres in normal or variant cases and its effect on perfusion images.

A glimpse towards the vestigiality and fate of human vermiform appendix-a histomorphometric study.

INTRODUCTION: The vermiform appendix in human is considered to be a vestigial organ by most of the authors. Absence of appendix is already reported in Indian population. Whether the human appendix is performing any function is debatable but when present it can create trouble. So if there is no appendix we can escape the ill-effects of the organ. With this hope the study has been done to see whether the appendix is really going to be rudimentary or absent or not. Marerials and Methods: Length, external diameter, number of lymphoid follicles, maximum diameter of the follicle or submucous coat, thickening of the muscle coat and seromucosal thickening of freshly removed appendix from human cadavers were seen. After fixation in 10% formal saline tissues were stained with haematoxylin-eosin stain and photographs were taken. The results had been tabulated and statistically correlated. RESULT: The parameters like number of lymphoid follicles, length and diameter all are changed as per the age advancement which is strictly indicating some functional activities of the organ which is against the idea of vestigiality of the appendix. CONCLUSION: Human appendix cannot be called a vestigial organ unless the functional inactivity is proved. Lymphoid changes which occur after birth to provide the gut immunity is needed to be proved by further studies. There might be incidental absence or rudimentary appendix in human body, but that does not indicate that we would not have any appendix in future.

Bilateral absence of musculocutaneous nerve: a case report.

Detailed knowledge of course and distribution of nerves in the axilla and arm is very important in the management of nerve injuries particularly in case of their variations. Bilateral absence of the musculocutaneous nerve was found during routine dissection in a male cadaver. The dissected part was cleared to see the distribution of the muscles of the arm. The muscles of the flexor compartment were supplied by the median nerve, instead of the musculocutaneous nerve. The present case report of this anatomical variation of the nerves should help in management of nerve injuries in the axilla or the arm.

Morphological study of the attachment of sternocleidomastoid muscle.

INTRODUCTION: The sternocleidomastoid (SCM) muscle is a major muscle of the neck. Classically, this muscle is attached below the sternum and clavicle, although the mode of attachment might vary. As the SCM is related to numerous important neurovascular structures, its variable anatomy is clinically relevant, particularly for neck surgeries. A cadaveric study was performed to establish the variations present in the mode of attachment of the SCM muscle in an Indian population. METHODS: We studied the variations in the attachment of the SCM muscle during the dissection of 18 cadavers for undergraduate teaching in two medical colleges in West Bengal, India. RESULTS: Variations in the attachment of the SCM muscle were found in 5 (27.8%) specimens. Of these five specimens, three had unilateral variations and two had bilateral variations. In each specimen, the modes of presentation of the SCM and its fusion with the major bulk were also different. CONCLUSION: In this study, we found variations in the attachment of the SCM muscle in more than a quarter of the specimens dissected. Surgeons should bear in mind such variations when performing neck surgeries.

Three rare variations in the course of the gonadal artery / Tres raras variaciones en el trayecto de la arteria gonadal

The gonadal arteries, lateral branches of the abdominal aorta, usually arise distal to the renal vessels. Knowledge of the origin and course of them, particularly their relationships with renal vessels, are important for uncomplicated surgical procedures on the posterior abdominal wall. So the relationship of the testicular artery and renal vessels were studied in 80 cadavers in Calcutta National Medical College, India and detected three rare variations. We have discussed the possible clinical implications and embryological explanation with review of literature of those variations.

Las arterias gonadales, ramas laterales de la aorta abdominal, usualmente surgen distales a los vasos renales. El conocimiento del origen y trayecto de estas, particularmente sus relaciones con los vasos renales, son importantes para procedimientos quirúrgicos sin complicaciones en la pared posterior del abdomen. La relación de la arteria testicular y los vasos renales fueron estudiados en 80 cadáveres en la Escuela Nacional de Medicina de Calcuta, India y se detectaron tres variaciones raras. Se discuten las posibles implicancias clínicas y explicaciones embriológicas, con la revisión de la literatura de estas variaciones.