Gross anatomy of the pancreatic ducts in north Indians.

Gross anatomy of the pancreatic ducts was studied in dissections and by preparing corrosion casts of pancreases, obtained from 218 male and 57 female adult cadavers. In addition 72 normal pancreatograms were also examined. The main pancreatic duct (MPD) started as two or more tributaries in the tail of the pancreas and crossed the body of the 12th dorsal or the first lumbar vertebra or in between in 72.5% males and 62.5% females. In 96% specimens MPD followed the usual course and opened at the major duodenal papilla. Twenty to thirty five lobular ducts opened on either side of the MPD while a few opened on the anterior or posterior walls. There was no 'herringbone' arrangement. The distance between the two ductules varied from 1 to 10 mm. Mode of formation of the accessory pancreatic duct (APD), its course and termination were also studied. In dissected specimens the embryonic type of pancreatic duct (pancreas divisum) was seen in 9 (4.5%) male and 3 (6%) female specimens. In 15.1% male and 26.3% female (p < 0.05) subjects APD will not act as a safety valve if an obstruction occurs in the distal part of MPD.

Dimensions & shape of the trachea in the neonates, children & adults in northwest India.

Measurements of the trachea and the two main bronchi including the subcarinal angle and the angles of the bronchi with the vertical were taken in specimens obtained from 370 adults, 60 children and adolescents up to 17 yr and 27 dead newborns. These measurements showed a gradual increase with age up to a certain point (often 31-35 yr in males and 26-30 yr in females) and stabilised thereafter. There was no sexual dimorphism in measurements till the age of 17 yr and thereafter, the measurements were greater in males than in females (P < 0.001). In adults the body weight and supine body length had a significant correlation with certain measurements of the trachea. The subcarinal angle and the angles of the two main bronchi with the vertical were variable but the angle of the right bronchus with the vertical was always found to be smaller than that of the left. The incidence of different shapes of the trachea at transversely cut upper end was also studied. A U-shaped trachea was present in 33.2 per cent male adults but was not seen in females. This may have some medico-legal importance.

Incidence of myocardial bridges in northwest Indians.

Dissection of hearts obtained at autopsy from 150 adults (110 males, 40 females) and 15 children (10 males, 5 females) showed an incidence of myocardial bridges over the coronary arteries to be 34.5% in the male and 32.5% in female adults (p = NS); in children the incidence was 40% in either sex. A similar incidence was found in the neonates. Such bridges were also present in the fetuses. A bridge over the anterior interventricular artery could be identified as early as 60mm C.R. stage. An examination of serial sections of 3 early embryos indicated that the coronary arteries develop epimyocardially. The myocardial bridges seem to develop concurrently with the development of myocardium. In 63% instances a bridge was present on the anterior interventricular artery, other arteries were involved less frequently.

Aluminium phosphide poisoning: haemodynamic observations.

Haemodynamic measurements were made on 25 patients with aluminium phosphide poisoning. There was severe hypotension (mean arterial pressure 62.7 +/- 19.3 mmHg) and reduction in cardiac output (2.13 +/- 0.9 lit/min/m2). However, the systemic vascular resistance was only moderately elevated (2050 +/- 732 dynes/m2). The right atrial pressure was increased but the pulmonary artery and pulmonary capillary wedge pressures were normal, even in patients with pulmonary oedema. Thirteen patients (52%) who died had a lower cardiac output (p less than 0.05). Saline infusion significantly improved haemodynamics in some patients. Its judicious use early in the course of treatment may be beneficial.

Blood supply of the human interventricular septum in north-west Indians.

The blood supply of the human interventricular septum was studied in hearts obtained from 500 (300 males and 200 females) medicolegal autopsy subjects aged 18 to 75 years. In 350 specimens the coronary arteries were injected with 20 per cent solution of cellulose acetate butyrate and branches supplying the septum were displayed by dissection while in the remaining hearts the arteries were injected with a solution of barium sulphate and X-rays taken. The anterior two-thirds of the septum is supplied by 4 to 10 perforators and one or two long septal arteries (in 94 per cent instances) which arise from the anterior interventricular artery; the latter turns round the inferior border of the heart and extends for a variable distance in the caudal part of the interventricular sulcus and supplies perforators to the posterior one-third of the septum. The cephalic part of the posterior one-third of the septum gets its blood supply from the posterior interventricular artery; some variations in this arrangement have been encountered. In about 85 per cent instances the right coronary artery or its conus branch gives an interventricular septal branch which pierces the anterior wall of the right ventricle and runs subendocardially on the supraventricular crest to reach the interventricular septum where it anastomoses with the anterior perforators; about 15 per cent subjects who do not have this septal branch are likely to sustain a larger infarction in case the anterior interventricular artery gets blocked.

Origin and size of the coronary arteries in the north-west Indians.

The origin of the coronary arteries and sizes of their ostia were studied in 500 adult hearts (385 male and 115 female), obtained from medico-legal autopsies performed by one of the authors on subjects varying in age from 18 to 75 years and residents of Chandigarh zone. Third coronary artery was present in 34.8% male and 27.8% female hearts (p greater than 0.05). Whereas the incidence of the origin of right coronary artery above the supravalvular ridge was 3.4% in the males and 1.7% in females (p greater than 0.05), that of the left coronary artery was 7% in both sexes. The mean diameter of the origin of the right coronary artery in the males was 3.2 +/- 0.5 mm, and that of the females was 2.8 +/- 0.4 mm (p less than .001). The mean diameter of the left coronary artery in the males was 3.7 +/- .7 mm, and in famels 3.2 +/- .6 mm (p less than .001). The size of the left coronary artery in unsexed hearts of north-west Indian population was calculated as 3.6 mm while that of the right as 3.1 mm. The former is definitely smaller than that given in Western literature, while the size of the right artery is only marginally so. The sizes of both coronary arteries had significant correlationship with body weight, body weight, body surface area, heart weight and age. This investigation showed that the size of the coronary arteries increased with an increase in age.