Double non coronary aortic sinuses: an autopsy case finding showing the arterial variation / Senos aórticos dobles, no coronarios: un caso de autopsia que demuestra la variación arterial

We report a case of variant origin of the right coronary artery from the left posterior aortic sinus. This was observed routinely during a medico legal autopsy of a 58 year old male who died in a road traffic accident. Initially it was believed that the right coronary artery was absent since there was no obvious right coronary artery ostium from the anterior aortic sinus. However it was found later that the right coronary ostium was present just beside the left coronary ostium in the left posterior aortic sinus and the right coronary artery was arising from the left posterior aortic sinus. The right coronary artery had an intramural course between the aorta and pulmonary trunk, which is considered as very dangerous and life threatening. We believe that the present case report will be enlightening to the cardiologist and cardiothoracic surgeon. It is also true that the conduction of medico legal autopsies of coronary arteries is important for the medico legal resolution.

Se presenta un caso de variación de origen de la arteria coronaria derecha desde el seno aórtico posterior izquierdo. Esto se observó de forma rutinaria durante una autopsia médico-legal de un hombre de 58 años que murió en un accidente de tránsito. Inicialmente se creía que la arteria coronaria derecha estaba ausente ya que no había un ostium observable desde el seno aórtico anterior. Sin embargo, se descubrió más tarde que el ostium de la arteria coronaria derecha estaba presente justo al lado del ostium de la arteria coronaria izquierda en el seno aórtico posterior izquierdo y la arteria coronaria derecha se originaba del seno aórtico posterior izquierdo. La arteria coronaria derecha presentó un recorrido intramural entre la aorta y el tronco pulmonar, que se considera como muy peligroso y potencialmente mortal. Creemos que el presente trabajo será esclarecedor para el cardiólogo y el cirujano cardiotorácico. También consideramos que el conocimiento de la anatomía de las arterias coronarias es importante durante el desarrollo de la autopsia médico-legal para lograr alcanzar una correcta resolución del proceso medicolegal.

An Anatomical Study of Adult Sacrum With its Emphasis on its Sexual Dimorphism in South Indian Populition.

Aim: To study the various morphometric parameters of the dry sacra of unknown sex in South Indian population in detail and to determine their demarcating points in order to increase the efficiency of sexing in the given population. Methods: 87 dry adult human sacrum of known sex (42 males and 45 females), belonging to South Indian (Karnataka) region were obtained. Various parameters like Length (L), breadths (B), Transverse diameter of the body of the 1st sacral vertebrae (TS1) & Curved Length of Sacrum (CL) were obtained. From these parameters, Sacral Index (SI), Curvature Index (CI) and Corporo-basal Index (CBI) were calculated & from the obtained values demarking points (D.P) were calculated. The values were stastically analyzed. Results: Among these parameters, the values for the Length (L), Curved Length (CL) and Sacral Index (SI) were stastically significant Conclusion: Length (L), Curved Length (CL) and Sacral Index (SI) were useful parameters and by obtaining their demarking points, it helps in sexing the sacrum with greater accuracy.

A Novel Method for Coloring and Labeling Specimens in the Anatomy Museum.

Introduction: In today’s medical educational programs in various institutes anatomy is an essential part of the curriculum in the first year of the medical course. An attractive and innovative anatomical museum forms a vital role in furthering the interest and educating a medical student. Once a specimen has undergone fixation it is essential to color and label the specimens in order to ensure better visualization of required structures and for its proper placement in the museum. Materials and methods: We have utilized a novel method of using commercially available nail polish as a coloring agent and as a part of the labeling of museum specimens. Results: Nail polish being non- toxic and readily available can be used without causing any complications. Discussion: Commercially available nail polish is cost effective and non-toxic. Its various usages are described along with the techniques of labeling done in our anatomy museum.

An Anatomical Study of Foramen Spinosum in South Indian Dry Skulls with its Emphasis on Morphology and Morphometry.

Aim: To study themorphological details and to evaluate themorphometry of the Foramen Spinosum in the base of dry human skulls in South Indian population. Methods: 82 dry adult human skulls of unknown sex and of South Indian origin were obtained and variations in appearance were observed. The length and width of the Foramen Spinosum on both sides were determined using vernier calipers and area (A) was calculated and analyzed. Also, its mean distance from the midline on both the sides was noted and analyzed. Results: The values for the right side were 3.425± 0.637mm, 2.687± 0.487mm and 7.357 ± 2.195 mm2 and for the left side the values were 3.339 ± 0.660mm, 2.675 ± 0.465 mm and 7.110± 2.103 mm2 respectively, for the mean length,mean breadth andmean area of the Foramen Spinosum. Also, the shape of the Foramen Spinosum was typically round in most of the skulls studied (53.65%) and it was little away from midline on the left side. Conclusion: By analyzing the length, width and area of the Foramen Spinosum on both the sides, there was no statistical difference for the values obtained and these values were comparable with the studies done in the past.

Variability in the Origin of Lateral and Medial Circumflex Femoral Arteries: An Anatomical Study in South Indians.

Aim: The objectives were to study the anatomical variations in the origin of lateral and medial circumflex femoral arteries in cadaveric lower limbs of South Indian population. Material and method: The present study included 48 embalmed cadaveric lower limbs from the southern part of India. The branching patterns of femoral artery and deep femoral artery were observed in all the specimens. The branching patternwas categorized into different types as per Vazquez et al. The type 1a, the lateral circumflex femoral artery branched distal to the medial circumflex femoral artery and type 1b, the medial circumflex femoral artery branched distal to the lateral circumflex femoral artery. They are grouped under the type 1c, if both the circumflex femoral arteries, were found branching at the same level. Subtype 2a, if the lateral circumflex femoral artery is branching fromthe deep femoral artery and themedial circumflex femoral artery is branching from the femoral artery. Type 2b, if the medial circumflex femoral artery is branching from the deep femoral artery and the lateral circumflex femoral artery is branching from the femoral artery. In type 3, both the lateral and medial circumflex femoral arteries were branching from the femoral artery. Results: In the present study, the type 1awas observed in 43.7% of specimens, type 1c in 12.5%of cases, type 2a was found in 33.3% specimens, type 2bwas observed in 6.2%cases and type 3 in 4.2%of cases. The type 1b was not observed in the present study. Conclusion: The present study has provided additional knowledge about the variability in the origins of lateral and medial circumflex femoral arteries in the cadaveric lower limbs of South Indian population. The morphological knowledge will enlighten the surgeons to avoid complications like catastrophic bleeding and diagnostic misinterpretations.

Morphometric parameters of the human adult kidney: an anatomical study / Parámetros morfométricos del riñon humano adulto: un estudio anatómico

The purpose of this study was to determine the anatomic parameters of the kidney in adults. The Renal lengths, width at superior and inferior poles, thickness at the superior and inferior poles were measured in 151 adult cadaver kidneys. A digital vernier caliper was used for performing the measurements. The data were statistically analyzed. The mean renal length was 8.9 ± 0.9 cm on the right side and 9.1 ± 0.9 cm on the left side. The mean width of the superior pole of the right kidney was 4.9 ± 0.6 cm and the left kidney was 5 ± 0.7 cm. The width of inferior pole of the right and left kidneys were 4.8 ± 0.6 cm and 4.5 ± 0.7 cm respectively. The mean thickness of the superior pole of the right kidney was 3 ± 0.4 cm and left kidney was 3.2 ± 0.5 cm. The mean thickness of the inferior pole of the right and left kidneys were 3.1 ± 0.4 cm and 3.2 ± 0.5 cm respectively. There was no statistical significance with respect to the length of both the kidneys. However there was some data on width and thickness among the right and left side showed the difference which was significant statistically. The present study has provided additional information on the renal morphometry which will be of use to the surgeons and radiologists.

El propósito de este estudio fue determinar los parámetros anatómicos del riñon en los adultos. La longitud renal, ancho de los polos inferior y superior, y grosor de los polos superior e inferior se midieron en riñones de 151 cadáveres adultos. Se utilizó un caliper vernier digital para realizar las mediciones y los datos fueron analizados estadísticamente. La longitud media renal fue 8,9±0,9 cm en el lado derecho y 9,1±0,9 cm en el lado izquierda. El ancho promedio del polo superior del riñón derecho fue 4,9±0,6 cm y del riñón izquierdo fue 5±0,7 cm. El ancho promedio del polo inferior del lado derecho e izquierdo riñones fueron 4,8±0,6 cm y 4,5±0,7 cm, respectivamente. El grosor promedio del polo superior en el riñón del lado derecho fue 3±0,4 cm y el izquierdo 3,2±0,5 cm. El grosor promedio del polo inferior del riñon del lado derecho e izquierdo fueron 3,1±0,4 cm y 3,2±0,5 cm, respectivamente. No hubo diferencia significativa en relación con la longitud de los riñones. Sin embargo hubo algunos datos en ancho y grosor entre el lado derecho e izquierdo que mostraron diferencia significativa. El presente estudio ha proporcionado información adicional sobre la morfometría renal que puede ser de utilidad para los cirujanos y radiólogos.

Accessory neurovascular foramina on the lingual surface of mandible: Incidence, topography, and clinical implications.

Context: It was suggested that the accessory neurovascular foramina of the mandible might be of significance in relation to the effectiveness of local anesthesia following the routine inferior alveolar nerve block. Aims: To investigate the incidence of neurovascular foramina over the lingual surface of the mandible in South Indian population. Settings and Design: The study was conducted at the department of anatomy. Materials and Methods: The study included 67 human adult dry mandibles, the exact ages and sexes of which were not known. The location and number of neurovascular foramina were topographically analyzed. Statistical Analysis Used: Descriptive statistics. Results: The foramina were observed in 64 mandibles (95.5%) and were often multiple in most of the cases. They were located between the two medial incisors in 8 mandibles (1.9%), between the medial and lateral incisor in 34 mandibles (50.7%; 25-bilateral; 7-right; 2-left), between the lateral incisor and canine in 7 mandibles (10.4%; 2-bilateral; 3-right; 2-left), between the canine and first premolar in 6 cases (8.9%; 3 on each side). Foramina were also present around the genial tubercle in 56 mandibles (83.6%). Among them, 52 mandibles showed a single foramen just above the genial tubercle, 34 mandibles had foramina below the tubercles, 13 mandibles had foramina on the right side of genial tubercle and 17 were having on the left side. Conclusion: Since the anatomical details of these foramina are important to various fields of dentistry and oncology, the present investigation was undertaken. The clinical significance and implications are emphasized.

Lumbosacral transitional vertebrae: a case report and clinical implications / Vértebras lumbosacras de transición: reporte de un caso e implicancias clínicas

A lumbosacral transitional vertebra is a rare congenital anomaly which occurs because of defect in the segmentation of the lumbosacral spine during development. During routine osteology classes for the medical students at the Kasturba Medical College, Mangalore, India, one of the sacra showed the fusion of the fifth lumbar vertebra with the sacrum. The specimen showed an incomplete fusion (sacralization) on the left side and the transverse process was of the large butterfly shape, while on the right it was about the usual size. Though this variation is well known, the details of this anomaly are rarely reported in the anatomical literature. Since there is a strong relationship between the lumbosacral transitional vertebrae and low back pain, this anomaly has gotten increased clinical interest. So this case was studied in detail with relevant review of literature and its surgical, radiological implications are discussed.

Una vértebra de transición lumbosacra es una anomalía congénita rara que se produce debido a defectos en la segmentación de la columna lumbosacra durante el desarrollo. Durante una clase de osteología para estudiantes de medicina en Kasturba Medical College, Mangalore, India, una de las regiones sacras mostró fusión de la quinta vértebra lumbar con el sacro. El especimen mostró fusión incompleta (sacralización) en el lado izquierdo y el proceso transverso tenía forma de mariposa grande, mientras que en el derecho se observó de tamaño normal. A pesar que esta variación es conocida, los detalles de esta anomalía rara vez son reportados en la literatura anatómica. Puesto que existe una fuerte relación entre las vértebras de transición lumbosacra y el dolor de espalda baja, esta anomalía tiene gran interés clínico. Este caso fue estudiado en detalle con la revisión pertinente de la literatura, y son discutidas sus implicancias quirúrgicas y radiológicas.

Morphometric study of the humerus segments in Indian population / Estudio morfométrico de los segmentos del húmero en población india

The aim of the present study was to obtain the measurements of the different humerus segments and to estimate the length of humeri from them. For this purpose 100 (51 left and 49 right) sex-aggregated, adult dry humerus from Indian population, were taken to analyze the morphometric details of the humerus segments. The distance between five different segments viz: most proximal point of the humeral head and greater tuberosity (HA), head of the humerus and surgical neck of humerus (HB), proximal and distal point of olecranon fossa (HC), the distal point of olecranon fossa and trochlea of humerus (HD), proximal point of olecranon fossa and distal point of trochlea of humerus (HE) and finally the maximum length of humerus (HL) were obtained by means of an osteometrical board and an analogical caliper. Simples linear regressions (p < 0.01) were made to correlate each segment with the total length of the humerus. Positive results were obtained in segments HB and HE of right humerus. Regressions formulae were obtained to define these estimative. In conclusion, our study demonstrated that length of the humerus can be estimated from measures of different segments of humerus and this study helps in forensic, anatomic and archeological cases in order to identify unknown bodies and to determine stature of the individual and as well as for the orthopedic surgeons for the treatment of proximal and distal humerus fractures and for their reconstruction.

El objetivo del estudio fue obtener las medidas de diferentes segmentos del húmero y calcular la longitud del húmero a partir de ellos. Fueron seleccionados 100 (51 izquierdos y 49 derechos) húmeros adultos secos, separados por sexo, de población india para analizar los detalles morfométricos de los segmentos dle hueso. La distancia entre cinco segmentos diferentes fueron establecidos: punto más proximal de la cabeza humeral y la tuberosidad mayor (HA), cabeza del húmero y cuello quirúrgico del húmero (HB), punto proximal y distal de la fosa olecraneana (HC), punto distal de la fosa olecraneana y la tróclea del húmero (HD), punto proximal de la fosa olecraneana y punto distal de la tróclea del húmero (HE) y, finalmente, la longitud máxima del húmero (HL) medidas obtenidas por medio de una tabla osteométrica y un caliper análogo. Se realizaron regresiones lineales simples para correlacionar cada segmento con la longitud total del húmero. Se obtuvieron resultados positivos en los segmentos de HB y HE de húmero derecho. Fórmulas de regresión se obtuvieron para definir estimativos. En conclusión, nuestro estudio demostró que la longitud del húmero puede estimarse a partir de las medidas de los diferentes segmentos del hueso, ayudando en casos forenses, anatómicos y arqueológicos con el fin de identificar cuerpos desconocidos o para determinar la estatura de la persona, así como a cirujanos ortopédicos para el tratamiento de las fracturas proximales y distales del húmero o para su reconstrucción.

ESBL production: Resistance pattern in escherichia coli and klebsiella pneumoniae, a study by DDST method.

Objectives: Resistance to third generation cephalosporins in E. coli and K. pneumoniae are due to various factors. The present study was undertaken to detect resistance mediated by ESBL’s. Multidrug resistance in isolates producing ESBL was also studied. Methods: The study included a total of 200 clinical specimens which include 95 urine, 45 pus, 32 sputum, 11 blood, 9 throat swabs, 6 suction tips and 2 vaginal swabs. The E. coli and K. pneumoniae isolates which were screen positive were studied for ESBL production by DDST method. Results: Culture of 200 samples yielded 200 isolates (117 E. coli and 83 K. pneumoniae). Out of these, 98 (49%) were screen positive for ESBL. Among them 79 (53 E. coli and 26 K. pneumoniae) were found to produce ESBL. Among them, 4 (7.6%) isolates of E. coli and 4 (15.3%) isolates of K. pneumoniae were positive by DDST method. The prevalence of 39.5% of ESBL production was noted in the present study. Among ESBL positive isolates, 98.1% were resistant to cefoxitin, however all of them were susceptible to imipenem. Conclusion: The prevalence of ESBL producing E. coli and K. pneumoniae was found to be high and routine screening of ESBL should be preformed on all isolates showing decreased susceptibility to one or more of third generation cephalosporins.

Morphometric analysis of the menisci of the knee joint in South Indian human fetuses / Análisis morfométrico de los meniscos de la rodilla en fetos humanos del Sur de India

The morphometrical data related to the menisci of the adults have been reported by few authors and that of the fetuses have not been reported. The aims of the present study were to analyse the external circumference thickness, the width, peripheral and inner border lengths, and the distance between anterior and posterior horns of the fetal menisci and to compare the meniscal dimensions with that of the adult meniscal parameters which are available in the literature. The menisci from 106 knee joints of the formalin fixed South Indian fetuses which were obtained from the anatomy department were analysed. The fetuses which had musculoskeletal anomalies were excluded from the study. A vernier caliper of 0.02 mm accuracy and a non elastic cotton thread were used for the morphometry. After comparing the meniscal dimensions of the present study with the adult meniscus parameters, we established that the fetal parameters of the meniscus are entirely different from the adults. These differences are may be due to the mesenchymal differentiation or variability of the vasculature early in embryonic life. We believe that our study will provide support to the fetal anatomy, concerning surgical procedures and arthroscopy of the knee joint. Since the morphometric studies of the fetal menisci are not reported, this study may be considered new and needs to be studied further with different groups of fetuses from various stages of intrauterine development. This study is important not only for orthopedic surgeons, but also for morphologists and embryologists.

Los datos morfométricos relacionados con los meniscos de los adultos han sido reportados por algunos autores, mientras que en fetos éstos aún no han sido descritos. El objetivo del estudio fue analizar, en fetos, el grosor de la circunferencia externa, ancho, y longitud de los márgenes interno y externo, asi como la distancia entre los cuernos anteriores y posteriores. Además, comparar las dimensiones del menisco fetal con los parámetros de adultos disponibles en la literatura. Fueron analizados los meniscos de 106 articulaciones de rodillas fijadas en formalina, pertenecientes a fetos del sur de la India, obtenidos desde el Departamento de Anatomía. Los fetos con anomalías musculoesqueléticas fueron excluidos del estudio. Un pie de metro de 0,02 mm de precisión junto a hilo de algodón no elástico fueron utilizados para la morfometría. Después de comparar las dimensiones del menisco del presente estudio con los parámetros de meniscos adultos se estableció que los meniscos fetales son totalmente diferentes a los adultos. Estas diferencias pueden deberse a la diferenciación mesenquimal o la variabilidad de temprana vasculatura en la vida embrionaria. Creemos que nuestro estudio prestará apoyo a la anatomía fetal, en relación con los procedimientos quirúrgicos y la artroscopía de la rodilla. Los estudios morfométricos no han informado datos en meniscos fetales, por lo que esta investigación puede ser considerada novedosa y requiere seguir siendo estudiada con diferentes grupos de fetos en las diversas etapas del desarrollo intrauterino. Además el estudio de ser importante para los cirujanos ortopédicos, también lo es para morfólogos y embriólogos.