Abnormal origin of right subclavian artery – A cadaveric study.

Background: During early embryonic life, the aortic arch undergoes complex development and normally results in the formation of a left aortic arch from which three arteries arise: (1) the brachiocephalic artery, which divides into the right common carotid and right subclavian arteries, (2) the left common carotid artery and (3) the left subclavian artery. In the present study we found an aberrant right subclavian artery arising from the arch of aorta distal to the left common carotid artery. Aims & Objective: Abnormalities of branches of arch of aorta are not uncommon and they have been identified more frequently with increasing use of imaging studies. However, the clinician should be aware of the wide range of anomalies that occur in the arch & the great vessels. This could help in adequately managing these variations in emergency approaches to the arch & the great vessels when imaging studies are not available. Our aim is to report the occurrence of the abnormal origin of right subclavian artery in a sample of western Indian population. Material and Methods: Present study was conducted on embalmed cadavers in Anatomy Department at various medical colleges in Gujarat. Branches of arch of aorta were dissected & observed for any variation. Results: A total of 70 cadavers were dissected. In one cadaver we found abnormal origin of right subclavian artery from the arch of aorta. The anomalous artery was passing behind the oesophagus. (1.43%, n = 70) Conclusion: An aberrant right subclavian artery is a rare vascular anomaly & it is also an unusual cause of problems with the passage of solid food through the oesophagus. Recently it has been suggested that it occurs more frequently in patients with Down syndrome. Knowledge of this anomaly is important while evaluating feeding difficulties in patients with Down syndrome as well as in preventing vascular complications in patients with aberrant right subclavian artery.

A study on variation in the insertion of Coracobrachialis muscle and its clinical importance.

Background: The coracobrachialis muscle morphologically represents the adductor group of muscles in the arm but such function became insignificant in man during the process of evolution. It is more important morphologically than functionally & it is known for its morphological variations. Aims & Objective: Variations in the structures of the human body are of importance to clinicians while performing any surgery or procedure or in the diagnosis of certain clinical conditions. Our aim is to report the occurrence of variation in insertion of coracobrachialis muscle & to observe the relationship of its abnormal slip with the median nerve & brachial artery. Material and Methods: Present study was conducted on embalmed cadavers at various medical colleges in Gujarat. The coracobrachialis muscle was dissected in both the upper extremities & observed for any abnormal slip or for any variation in insertion. Results: A total of 120 upper limbs of 60 cadavers were dissected. Variation at insertion was found in four cadavers as an abnormal slip to medial epicondyle of humerus & to the deep fascia on the medial aspect of arm. [6.66 % , n = 60] Conclusion: Anomalous insertion of coracobrachialis muscle may lead to compression of median nerve & brachial artery. The knowledge of such variations are of importance for surgeons, orthopaedicians, neurologists, radiologists & physiotherapists while dealing with injuries or operations around elbow joint. This muscle can also be used in muscle transplants.

Morphometric analysis and sex determination from clavicles in Gujarati population.

Background and Objectives : To determine sex from unknown skeletal remains is vital. Various methods to do this on different bones of human skeleton have been extensively studied. In general male bones are heavier larger and muscular markings are more prominently seen as compared to female bones. The objective of this study was to find out comparative differences between the right and left clavicles from certain metrical parameters and to enable assessment of sex from unknown clavicles. Methods: The study was conducted on 213 adult clavicles, out of which 96 were of the right side and 117 were of the left. The maximum length of clavicles in mm was taken and demarking points were established by adding and subtracting 3×SD from means. Results: The mean length of right clavicle was 142.28 mm ± 11.40 mm SD and that of left clavicle was 145.14 mm ± 11.87 mm SD. It has been observed that left clavicle is longer than right clavicle by 2.82mm. Depending upon length of clavicle the sex can be decided in 3.13% male and 2.08% female in right clavicles and 1.71% male and 1.71% female in left clavicles. Conclusion: The left clavicle was longer compared to right clavicle. Demarking points give 99.75% accurate data, measured by adding & subtracting 3×SD from means. Demarking points for length of clavicles were >176.48 mm for male & <108.08 mm for female on right side and >180.75mm for male & <109.53 mm for female on left side for this study. This study is useful for medico legal and anthropological examination of bones and for academic studies in anatomy.

Higher bifurcation of brachial artery with superficial course of radial artery in forearm: A study report.

Background: Normally brachial artery divides into its terminal branches namely radial and ulnar arteries at the neck of the radius in the cubital fossa and these are the main arteries responsible for the irrigation of the forearm. In the present study we found higher division of brachial artery into radial and ulnar arteries with superficial course of radial artery unilaterally during routine dissection for MBBS student. Accurate information regarding these variations is important during vascular and re-constructive surgery and also in evaluation of angiographic images. Aims & Objective: The altered anatomy of the blood vessels may make them more vulnerable to trauma and to haemorrhage but at the same time more accessible for cannulation. Our aim is to report the occurrence of the higher division of brachial artery with superficial course of radial artery in a sample of western Indian population. Material and Methods: A prospective evaluation was conducted on cadavers at various Medical Colleges, in Gujarat. The upper limbs of cadavers were dissected and observed for any variation in the course of brachial artery and its terminal branches radial and ulnar arteries. Results: A total of 96 arms of 48 subjects were studied. In three upper limbs we found higher division of brachial artery with superficial course of radial artery. The variant was present unilaterally in left upper limb of three males (6.25%, n = 48). Conclusion: Anomalies in origin and course of principal arteries have practical importance for orthopaedicians, radiologists and vascular surgeons. Awareness of incidence of this variation is necessary to avoid complication during pre-operative procedure or surgeries in the upper limb.

A study of sacrum with three pairs of sacral foramina in western India .

Background: The sacrum is a large, triangular fused five sacral vertebrae and forms the postero-superior wall of the bony pelvis. Numerous anatomical variations of the sacrum have been reported including complete bilateral lumbarization of the first sacral vertebra in different race generates sacrum with three pairs of sacral foramina. There has never been reported among Gujarati population in Western India. These variations may be found in the living during radiological investigations for pain and neurological symptoms of patients or may be found during post mortem examination or during dissection of human body and osteology class for first M.B.B.S students. Objective: The study was designed to know the prevalence of sacrum with three pairs of sacral foramina among Gujarati population in Western India as there is paucity of available literature. Considering the variation, we conduct this study as a prelude to any type of experimental work in biomechanics, for diagnostic and therapeutic purposes in low back pain, spinal surgery and for interventional procedures like spinal anaesthesia and lumbar puncture. Materials and Methods: Observational study was carried out on 189 dry human sacra of known sex(115 male and 74 female) were studied from Department of Anatomy, B.J. Medical college Ahmedabad, Government Dental college Ahmedabad, Medical college Vadodara and Government Medical College, Surat in Gujarat. Morphological study was done on the sacrum. The sacra consisting of four vertebral segments were selected. The specimens were then carefully examined and recorded. Results: 189 dry human sacra were studied. Sacra with three pairs of sacral foramina were recorded. We founded 3 (1-Male, 2-Female) specimens of sacrum with three pairs of sacral foramina representing Bilateral complete lumbarization of first sacral vertebra. The degree of lumbarization varied: Bilateral complete lumbarization in 3 specimens and did not found Unilateral complete lumbarization specimen. Conclusion: The present study shows that the incidence of sacrum with three pairs of sacral foramina among Gujarati population in Western India is 1.58 %.The knowledge of this anatomical variation is of paramount importance to spinal surgeons, radiologists, forensic experts, morphologists and clinical anatomists.

A study of sacralisation of coccygeal vertebra in Gujarat.

Introduction: In the sacrococcygeal region anatomical variations are related with change in the number of sacral vertebra by union of first coccyx with sacrum. This study is carried to know the prevalence of sacralisation of coccygeal vertebra in Gujarat Method: The present study of sacralisation of coccygeal vertebra was carried out on 189 dry human sacra of gujarati population,115 male and 74 female. Result: Sacralisation of coccygeal vertebra was seen in 45(23.8 %)cases Conclusion:This study considers several issues pertaining to fusion of the coccyx to the sacrum,including prevalence,sexual differences,effect on pelvic size and obstetrical and evolutionary implications. Clinally,the sacralisation of coccygeal vertebra is of paramount importance to surgeons especially pediatric surgeons and obstetricians.as it is a less known variant.

Incidence of the third head of biceps brachii in western Indian population.

Backgrond: Biceps brachii is muscle of the flexure compartment of the arm. Anatomic variation of the biceps brachii muscle is one of the most variations in upper limb. The most common variation is a third head, but four, five or even seven heads have been reported. This variation may present as a group of accessory fascicles arising from the coracoids process, Pectoralis major tendon, proximal head of the humerus, articular capsule of the humerus or from humerus itself. Aim: to report the occurrence of the third head of biceps brachii in a sample Indian population along the western region of India, and to compare with other racial groups from previous study. Method: A prospective evaluation was conducted on cadavers at Govt. Medical College, Surat in Gujarat. The upper limbs of 32 cadavers were dissected and observed for variation in the origin and insertion of the biceps brachii muscle bilaterally. Result: A third head for the biceps brachii muscle were found in six arms. The variations were bilaterally. The short & long head were normal however third head was humeral origin and also arose from pectoralis major tendon and inserted into the conjoined tendon of the biceps brachii muscle as usual. The variant was present in three males (9.37%, n=32). Conclusion: Awareness of incidence of this variation is necessary to avoid complication during pre-operative procedure or surgeries in the upper limb.

Study of angle of femoral torsion in western region of India.

Background: The femur is thighbone. The angle of femoral torsion is the angle obtaining between the transverse axes of the neck and head that of the lower end of the bone. In the adult, the angle measures about 12 to 15 degrees, but it is considerably greater in the fetus and at birth averages 40 degrees. In postnatal development a reduction of the FNA angle usually occurs during growth. Aim: to evaluate femoral torsion value on dried femora and to find the difference between Japanese, Caucasian and Indian femoral torsion. Method: The present study was carried out on 200 dry normal adult human femora. The bones studied were free of any pathological condition. The male bones were 117 and 83 were female femora out of 200 dried femora. Out of 111 were left and 89 were right femora. The gender of each specimen was determined by the recognized established practice. The angle of anteversion as measured by placing the femur on the osteometric board, the horizontal surface represents the retrocondylar axis and the plane of reference against which the anteversion is measured with the help of the axis of head and neck of the femur. Results: The average anteversion is 16.1 and 15.65 on the right and left sides respectively in male, 18.17 and 17.95 on the right and left sides respectively in female. Statistical analysis using ‘z’ test revealed significant (p<0.05), greater average anteversion in female bones and right-left variations, being greater on the right side. Conclusion: The objective measurement of this angle is of paramount importance in orthopedic surgery for total replacement to attain a normal activity of the replaced joint.