Variation Of Roots In The Formation Of Median Nerve

Background: Median nerve formation exhibits several variations in the form of additional roots and /orcommunications which are relevant to the surgical explorations of shoulder, axilla and arm.Aim: To study the variations in the formation of median nerve and its communications with musculocutaneousnerve in cadaveric upper limbs.Materials and Methods: The study was done in 34 formalin fixed cadavers (68 upper limbs) and 10 isolatedlimbs. All cadavers were conventionally dissected and observed for median nerve formation and dissected up tocubital fossa for presence of any communications.Observations: Out of the 78 upper limbs dissected, 12 limbs (15.38%) showed two lateral roots and one medialroot contributing to the formation of median nerve. One case of bilateral presence of extra lateral root wasfound. The extra lateral root or communication from the musculocutaneous nerve was arising distal tocoracobrachialis in 2 cases and proximal to the muscle in 10 cases. In three cases, absence of musculocutaneousnerve was observed and median nerve was supplying either all or some muscles of the flexor compartment. Oneof the cases of absent musculocutaneous nerve had two medial roots and one lateral root that is a very rarecombination of variation not reported in the literature. In all cases of two lateral roots, the median nerve wasformed medial or anterior to axillary artery. So we observed median nerve variation in 16 upper limbs [20.51%]Conclusion: Thorough understanding of variations in the formation and communications of median nerve and itsvascular relations is important for successful surgical outcome and clinical interpretation of lesions of thenerve.

Evaluation of Lumber Vertebral Canal at Disc Level in Symptomatic and Asymptomatic subjects: A Radiological Evaluation.

Background: Spinal stenosis is defined as the narrowing of central spinal canal or its lateral recesses. Stenosis of spinal canal becomes important only when it results in interference with the normal functions of the contents of the canal. Narrowing of spinal canal seems to be a normal part of advancing age but certain uncertainties persist as regards to radiological definition of lumbar spinal canal stenosis. Material & Method: The present study was aimed to evaluate the clinical relevance of stenosis of spinal canal through the most recent technique, MRI. Fifty symptomatic and 18 asymptomatic subjects were included. Antero-posterior and transverse diameters of vertebral canal were compared between symptomatic and asymptomatic subjects and statistically analyzed. Results & Discussion: The present study clearly shows that in both symptomatic and asymptomatic subjects there is a gradual decrease in the antero-posterior diameter from above downwards . The minimum anteroposterior and maximum transverse diameter was seen at L4L5 level making this level susceptible to compressive symptomatology. Apparent stenosis was observed in some asymptomatic subjects.

Crossed Renal Ectopia Without Fusion: A Multidetector Computed Tomography Study.

Background: Congenital positional, rotational and fusion anomalies of the kidney are frequently encountered. Crossed renal ectopia is a condition in which the kidney is located on the side contralateral to its ureteral insertion into the urinary bladder. Crossed renal ectopia without fusion is a very rare anomaly sporadically reported in the literature. We have attempted to analyse such renal anomalies in a large series of patients. Materials & Methods: Contrast enhanced multidetector computed tomographic scans of 960 patients (491 males and 469 females, age range 4-90 years) were reviewed . Observations: Crossed renal ectopia without fusion was detected in three patients (0.31%; 1 in 320 cases). All three patients were males and left- to-right renal ectopia was noted in two cases and right-to-left ectopia in one case, in whom the ectopic right kidney was exhibiting multicystic dysplasia. An interesting observation was vascularisation of crossed ectopic unfused left kidneys by branches arising from the right common iliac artery. Conclusion: Crossed renal ectopia without fusion is an extremely rare anomaly and may remain asymptomatic without being detected. Multidetector computed tomography angiography is an excellent imaging modality to detect renal positional and rotational anomalies. To the best of our knowledge the present study is the first study to detect renal anomalies in a large series of cases.

Crossed Fused Renal Ectopia Multidetector Computed Tomography Study.

Crossed renal ectopia is one of the rarest congenital malformations where a kidney is located on the side opposite to the side of its ureteral insertion into the urinary bladder and is generally fused with the normally located ipsilateral mate. Generally this anomaly remains as a silent clinical entity and is incidentally detected during evaluation for other conditions. We report here three such cases of crossed fused renal ectopia detected by multidetector row contrast enhanced computed tomography. Crossed fused renal ectopia of inferior type was observed in a male on the right side with the ureter of the ectopic left kidney crossing the midline. In two female patients, L-shaped or tandem kidney was noted, one on the right and another on the left side. Over all in two cases the left kidney was ectopic and in one the right kidney. No renal pathologies like urinary tract infection, nephrolithiasis or hematuria were found in our patients.