Morphometric Analysis Of Tendoachilles Tendon With Its Clinical Implications

Background: Tendoachilles tendon, the strongest and thickest tendon of the body, is formed by tendons of soleusand gastrocnemius begins near the middle of the back of leg and is inserted to the midpoint of the posteriorsurface of the calcaneum. Normal morphometric measurements of Achilles tendon serve as an important landmarkin its anthropometric evaluation and biomechanical attribute. The morphological changes in the tendon sizeprovide important health information for the management of various clinical conditions related to Achillestendons like simple tendinopathy or acute ruptures of it etc.Aim: The current study aimed at finding out the detailed morphometric measurements of the Achilles tendonwhich can be of substantial use to clinicians for determining any pathological conditions associated withtendoachilles.Materials and Methods: Total 108 lower limbs from 54 donated embalmed cadavers (31 males & 23 females) ofage between 55 to 85 years were procured for dissection. The study was carried out in the department of AnatomySMIMER Surat.Results: Present cadaveric study found that the length of tendoachilles was significantly high in male than infemale and no statistically significant difference in length of tendoachilles between right and left side werenoted. The width of the tendoachilles at origin between the right and left side tendons was statistically significant.Discussion: We found that the length of Tendoachilles was significantly high in male than in female and alsowidth of the tendoachilles at origin was more on right side. Being a frequent site for rupture, degenerative changeand inflammation, knowledge pertaining to normal morphometric measurements of Achilles tendon is imperativebefore determining any pathological variations associated with the tendon and

Cadaveric Study Of Aberrant Tendoachilles Tendon In South Gujarat Region And Its Clinical Significance

Background: The tendoachilles tendon is the strongest and thickest tendon in the body begins near the middle ofthe back of leg which is made up of the tendons of the soleus and two heads of the gastrocnemius muscles andis attached to the midpoint of the posterior surface of the calcaneum. An aberrant (abnormal) tendoachilles isattached to just posterior to the tendo-achilles tendon, calcaneal tuberocity and on medial aspect of calcaneum.An aberrant tendoachilles tendon is responsible for resistant equines deformity of club foot. The existence ofaberrant tendoachilles tendon should be kept in mind by the orthopedic surgeons, podiatrist, sports physiciansand physiotherapists. A lack of awareness such variations might complicate surgical repair.Aim: The current study aimed at finding out the attachment of tendoachilles tendon, presence of any aberrant(abnormal) tendoachilles tendon insertion and related clinical significance i.e. resistant club foot.Materials and Methods: 108 lower limbs, 54 right and 54 left lower limbs of 54 donated embalmed cadavers (31males & 23 females) of age group ranging from 55 to 85 years were procured for dissection. The study wascarried out for a period of 7 years in the department of Anatomy SMIMER Surat.Results: The length of the tendoachilles tendon is 0-2cm in 3.70% of cases, 2-4 cm in 25.92% of cases, 4-6 cm in53.70% of cases, 6-8 cm in 9.25% of cases, 8-10 cm in 5.55% of cases, >10 cm only in 1.85% of cases. In all cases,attachment of tendoachilles tendon was found on posterior aspect of calcaneun that is normal. In addition tothat one of the case of left lower limb (0.92% of cases), tendoachilles tendon was found attached on medialaspect of calcaneun that is called as aberrant tendoachilles tendon.Conclusion: Aberrant tendoachilles tendon is responsible for resistant equines deformity of club foot. Most ofresistant club foot can be treated with use of an extensive posteromedial release of aberrant tendoachillestendon with satisfactory functional results. The presence of such aberrant tendoachilles tendon should be keptin mind by the orthopaedicians. A lack of awareness such variations might complicate surgical repair.

Anatomy of accessory maxillary sinus ostium with clinical application.

Background: The “osteomeatal complex” of the middle meatus is a group of anatomical structures that includes; principle maxillary sinus ostium and accessory maxillary sinus ostium. Its beauty lies in its complexity. This osteomeatal complex contributes to the final common drainage pathway of maxillary, anterior ethmoidal and frontal sinuses. Principle maxillary sinus ostium (PMO) is universally present in all population while if extra opening is present in addition to principle maxillary sinus ostium then this is called accessory maxillary sinus ostium. The principle maxillary sinus ostium is opened in the Hiatus semilunaris and it is located on the highest part of medial wall of maxillary sinus as compared to accessory maxillary sinus ostium. Accessory maxillary sinus ostium located in the anterior nasal fontanelle (ANF), posterior nasal fontanelle (PNF), and hiatus semilunaris. Aims & Objective: The endoscopic sinus surgeons must have a detailed knowledge of inconsistent situation of principle maxillary sinus ostium (PMO) and accessory maxillary sinus ostium as there are important structures like orbit superiorly and nasolacrimal duct medially lying adjacent to medial wall of maxillary sinus where above said openings are situated. Materials and Methods: This study was carried out in the department of Anatomy of government medical college, Surat and Surat municipal institute of medical education and research (SMIMER) where 54 cadaveric heads were cut in midsagital section into 108 half heads and then incidence, location and side of accessory maxillary ostium was studied. Results: Among 108 half heads, accessory maxillary ostium was found in 20 (18.5%) half heads. Out of these 20 half heads, in 12 (60%) half heads accessory maxillary sinus ostium is present on right side while in remaining 8 (40%) half heads, it is on the left side. Similarly out of these 20 half heads, 16 (80%) half heads shows unilateral accessory maxillary sinus ostium either on right side or on left side while 4 (20%) half heads shows bilateral accessory maxillary sinus ostium. Out of these 20 half heads, 7 (35%) half heads shows double AMO (which includes 4 (20%) in ANF on the left side, 2(10%) in PNF on the right side and 1 (5%) in HS on the right side) while 13 (65%) were single in number (which includes 9 (45%) in ANF on both left and right side, 4 (20%) in PNF). All double accessory maxillary sinus ostia situated in the ANF and HS were placed in horizontal plane whereas accessory maxillary ostium which was situated in the PNF was placed vertically. Accessory maxillary sinus ostium was varies in size and shape. These accessory maxillary sinus ostia were 0.5 to 5 millimeters in size and round or oval in shape. Similarly out of these 20 (18.5%) half heads in which Accessory maxillary sinus ostia were present 70% Accessory maxillary sinus ostia were found in the anterior nasal fontanelle (ANF), 25% in posterior nasal fontanelle (PNF), and 5% in hiatus semilunaris (HS). Most of the accessory maxillary sinus ostia (65%) were single in number at the various places while double accessory maxillary sinus ostia were also found 20% in the ANF, 10% in the PNF 5% in the HS. Conclusion: Clinically the presence of accessory maxillary sinus ostium is extremely beneficial for surgical intervention of the functional endoscopic sinus surgery which is designed to remove the blockage of maxillary sinus ostium and to restore normal sinus ventilation and mucociliary function.

Forensic diagnosis of sudden death due to pyogenic meningitis.

Acute bacterial meningitis remains a major cause of mortality and long term neurological sequelae worldwide. Despite of availability of potent antibiotic the mortality rate due to acute bacterial meningitis remains significantly high in India and other developing countries. There is a need for periodic review of bacterial meningitis worldwide, since the pathogens responsible for infection vary with time, geography and patient‘s age. We are reporting a case of 40 years old married male who became unconscious suddenly with history of fever since last one day. There was no history of any major illness. He was died in hospital under suspicious condition within 12 hours of hospitalization. Forensic experts finally gave the opinion that the death was natural and it was due to pyogenic meningitis after considering autopsy findings, histo-pathological findings and microbiological and biochemistry reports. Klebsiella pneumoniae was responsible for acute pyogenic meningitis.