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BACKGROUND: Studies on the anatomy of the liver have helped surgeries such as liver resection. Liver resection is of significance in liver transplantation. In liver resection, the anatomy of segment IV is very important as it is more prone to ischemia. AIM: The primary objective is to study the anatomical variations of the hepatic artery and hepatic vein of segment IV from MDCT images of the hepatic vasculature in living liver donors. This study aims to document the anatomy of the hepatic artery supplying segment IV and its venous drainage in 300 living liver donors. MATERIALS AND METHODS: In this retrospective study, 600 MDCT images of hepatic vasculature were observed, and the interpretations were recorded. The origin of the artery to segment IV was documented. The observations of the hepatic vein were tabulated as classified in Nakamura's study. RESULTS: Segment IV artery originates from the left hepatic artery (LHA) in 72% of the cases and the right hepatic artery (RHA) in 23%. Hepatic venous drainage of segment IV comprises type I, type II, and type III in 14.33%, 53.67%, and 30% of cases, respectively. Type I anatomy of the hepatic vein is preferred in both right and left lobe liver transplantation as the drainage from segment IV is safe. CONCLUSION: Vascularity to segment IV is key in living liver donors, as donor safety is of utmost importance in the case of living donor liver transplantation.
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Background The diameter of coronary arteries serves as a potential predictor of coronary artery diseases (CADs) that can lead to sudden death. Factors such as gender, age, and coronary artery dominance play a role in influencing the size of normal coronary arteries. The outcome of coronary interventions, to a certain extent, depends on luminal size. Given the considerable variability in luminal size within the normal population, establishing the baseline size of normal coronary arteries in a specific population can aid in estimating the severity of coronary disease and predicting the outcome of interventional procedures. The current study focuses on estimating the luminal diameter of normal coronary arteries within the context of age, gender, and cardiac dominance in the South Indian population. Methods A retrospective study was conducted utilizing coronary angiograms with normal findings from 453 patients, comprising 257 males and 196 females, with a mean age of 54.66±10.66 years. These patients attended the outpatient service of the Cardiology Department at Amrita Institute of Medical Sciences, Kochi, a quaternary care center, between 2015 and 2017. The luminal diameter of coronary arteries is represented as mean±SD in millimeters. Results In the present study, we noted that the largest coronary artery was the left main coronary artery (LMCA, 3.59±0.58 mm), followed by the left anterior descending artery (LAD, 3.50±0.52 mm), the left circumflex artery (LCX, 3.31±0.57 mm), and the right coronary artery (RCA, 3.18±0.57 mm). We further broke down the statistics to evolve a gender pattern. In the raw comparison of data, the luminal size of coronary arteries in males was greater than in females, and statistical significance was noted in all except LAD. In males, the largest coronary artery was LMCA (3.70±0.60 mm), followed by LAD (3.54±0.48 mm), LCX (3.36±0.58 mm), and RCA (3.25±0.62 mm). In females, no significant size difference was observed between LMCA (3.45±0.53 mm) and LAD (3.46±0.55 mm). Females exhibited an increase in the size of LMCA with advancing age. Regardless of right or left cardiac dominance, LMCA was consistently larger than RCA in both genders. However, in cases of co-dominance, only males demonstrated significantly larger LMCA. Conclusion Precise knowledge of the size of normal coronary arteries and their influence by gender, age, and dominance can be crucial for the comprehensive evaluation of CADs and the success of interventional procedures.
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BACKGROUND: A single renal artery supplies the kidney in 70% of the population but variation exists in the remaining 30%. Multiple renal arteries (MRA) in different permutations and combinations are one of the many forms of variants. Lack of awareness of multiplicity could have detrimental effects on the outcome of renal surgery. The present study aims at identifying the variants of renal artery based on its origin, multiplicity, and portal of entry in a cohort of people belonging to Southern India and its clinical implications thereof. METHODS: Multi-detector CT (MDCT) images of renal vasculature of 100 kidneys from 50 live kidney donors who attended the Department of Nephrology of our institution, from 2016 to 2018 were collected and studied for variations in renal arterial anatomy. RESULTS: Out of the 18% of kidneys observed with multiple renal arteries, 88.8% had double renal arteries (DRA) and 11.1% had triple renal arteries (TRA). Common types of the double renal arteries were - two hilar arteries (31.3%) and one hilar with one inferior polar artery (IPA, 31.3%). Triple renal arteries types - 50% with one hilar, one superior polar, and one inferior polar; 50% with two hilar and one inferior polar artery. No statistically significant association was noted between the incidence of multiple renal arteries and its laterality (p-value=0.193). CONCLUSION: A thorough understanding of the renal artery variants is crucial for safe and efficacious uro-radiological interventional procedures.
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INTRODUCTION: The cruciate ligaments are essential for the antero-posterior stability of the knee joint. In Anterior Cruciate Ligament (ACL) rupture, though reconstructive surgery is a widely accepted and proven procedure, there is still an unacceptably high re-injury rate. The fact that the rotational instability persists even after the surgical reconstruction of ACL injury has evoked a new interest in the study of the soft tissue structures on the anterolateral aspect of the knee joint. The stability of the knee joint was found to improve dramatically if ACL reconstruction is accompanied with the reconstruction of the anterolateral soft structures of the knee. AIM: To identify the attachment and observe the measurable parameters of Antero Lateral Ligament (ALL) and its relationship with the adjacent bony landmarks. MATERIALS AND METHODS: Twenty six cadaveric specimens of knee joints were collected from the Department of Anatomy, Amrita School of Medicine, Amrita Institute of Medical Sciences, Kochi and were dissected for the anterolateral ligament. Various parameters of ALL in extended knee- the length, width at midpoint and at the femoral-tibial attachments and thickness- were measured. The relationship of femoral attachment of ALL with the lateral femoral epicondyle as well as the tibial attachment with the Gerdy's Tubercle (GT) and head of fibula were also noted. RESULTS: ALL was identified in all the 26 cadaveric knee specimens. It was 39.2±7.2 mm in length, 6.5±2.7 mm in width at femoral attachment and 7.4±3.4 mm at tibial attachment, while the thickness was 1.0±0.5 mm. At the femoral attachment it was 7.1±3.4 mm proximal to and 4.0±2.9 mm posterior to the lateral epicondyle while at the distal attachment it was 20.4±3.1 mm posterior to the GT and 21.33±4.6 mm anterior to the head of the fibula. CONCLUSION: The ALL was found to be a distinct, supporting anatomical structure on the anterolateral aspect of the human knee. There is a high incidence of ALL lesions in ACL injuries which causes high-grade pivot-shift. The reconstruction of ALL along with that of ACL could lead to a decrease in the re-injury rates. The anatomical descriptions and the morphometry of ALL may be of great value to the orthopaedic surgeons in performing a more effective reconstructive surgery of ACL.
