Unilateral Variation in the Branching Pattern of Axillary Artery: A Cadaveric Study.

During routine dissection of upper extremity in a 55-year-old male cadaver we noted a rare variation in the branching pattern of the axillary artery on the left side. The second part of the axillary artery was the source of all the branches of the axillary artery which arise normally from second and third part. The third part of axillary artery was related to the branches of brachial plexus and without giving any branches continued as brachial artery at the lower border of teres major. This finding has an embryological basis and clinical relevance. These variations in the branching pattern of axillary artery may be due to deviation in the development of the vascular plexus of the limb bud. Awareness of variation of axillary artery may serve as a guide for both radiologists and vascular surgeons. During surgeries for lymph nodes in the axilla and pectoral region, presence of such variations must be kept in mind.

Subcutaneous Course of Saphenous Nerve In Midthigh Region.

Saphenous nerve is a pure sensory nerve which may get compromised as a result of complication of a surgical procedure or entrapment leading to pain and numbness in the medial side of thigh, knee and leg. Secondly, adductor canal block is given very frequently now days to anaesthetize the saphenous nerve for providing analgesia after knee surgeries. During routine cadaveric dissection of the front of thigh, we observed an interesting finding that the saphenous nerve did not follow the usual course in the adductor canal. The saphenous nerve pierced the sartorius in the middle of adductor canal and became subcutaneous. This variant course of the saphenous nerve through the sartorius can be the site of entrapment or it may be the cause of failure of adductor canal block. Although saphenous nerve is a purely sensory nerve, in this condition there is possibility of having motor fibres also which may supply Sartorius while passing through it.

Vascular pattern of chorionic blood vessels of placenta and its correlation with the birth weight of neonate / Patrón vascular de los vasos sanguíneos coriónicos de la placenta y su correlación con el peso al nacer del recién nacido

Two hundred fresh full term placentae of normal pregnancies were collected from the department of Obstetrics and Gynaecology, RIMS, Ranchi, Jharkhand, India to observe the incidence of vascular pattern of chorionic blood vessels of placenta and to note the relationship between vascular pattern of placenta and the birth weight of neonate. Dye was injected into umbilical vessels under normal physiological pressure and diameter of chorionic blood vessels were taken at the centre and periphery. Two types of vascular pattern of chorionic blood vessels of placentae were observed- Dispersal and Magistral. Dispersal pattern was found in 63 percent cases and magistral pattern was observed in 37 percent cases. An interesting observation was noted that the birth weight of neonate was higher in magistral pattern in comparison to dispersal pattern in both sexes...

Doscientas placentas de término de gravidez normales frescas fueron recogidas del departamento de Obstetricia y Ginecología, RIMS, Ranchi, Jharkhand, India. Se observó la incidencia del patrón vascular de los vasos sanguíneos coriónicos de la placenta y la relación entre el patrón vascular de ésta y el peso al nacer del recién nacido. Se inyectó tinta dentro de los vasos umbilicales bajo presión fisiológica normal, y se tomaron los diámetros de los vasos sanguíneos coriónicos en el centro y la periferia. Dos tipos de patrón vascular coriónicos se observaron en la placenta, disperso y magistral. El patrón disperso se encontró en el 63 por ciento de los casos y el patrón magistral se observó en 37 por ciento de los casos. Una observación interesante mostró que el peso al nacer de los recién nacidos fue mayor en el patrón magistral en comparación con el patrón disperso en ambos sexos...

Ultrastructural changes in the placental membrane in pregnancies associated with diabetes / Cambios ultraestructurales en la membrana placentaria en embarazos asociados con la diabetes

Placenta is the most accurate record of the infant prenatal experience. If the placenta is examined minutely after delivery, it provides much insight into the prenatal health of the baby and the mother. The weight of placenta is higher in diabetic pregnancy in comparison to the normal pregnancy. To study the cellular changes that might contribute to more weight of placenta in diabetic pregnancies, light microscopic and electron microscopic analysis was performed. Twenty singleton pregnancies complicated with Gestational diabetes mellitus (12 controlled on diet, 8 controlled on insulin) were selected and compared to control group. Tissue sections were processed and analyzed. The placenta of diabetic pregnancies showed no abnormality on gross observation but light microscopic examination revealed, lesions like syncytial knots, fibrinoid necrosis, villous edema, villous fibrosis and capillary proliferation. Transmission electron microscopic examination (TEM) showed changes in almost all the layers of the placental membrane i.e. synctiotrophoblast, cytotrophoblast, trophoblastic basement membrane and fetal capillaries. These changes were observed in the placenta of both groups of patients whether blood sugar level was controlled by diet or insulin, but to different degree. It indicates that control of hyperglycemia only partially prevents the development of placental abnormalities which must be due to some other constituent factor of diabetic state.

La placenta es el registro más preciso de la experiencia prenatal infantil. Si la placenta se examina minuciosamente después del parto, ésta proporciona una visión más acabada de la salud prenatal de la madre y el bebé. El peso de la placenta es mayor en el embarazo con diabetes en comparación con el embarazo normal. Para estudiar los cambios celulares que podrían contribuir a un mayor peso de la placenta en los embarazos diabéticos, se llevó a cabo un análisis a través de microscopía óptica y electrónica. Fueron seleccionados 20 embarazos únicos complicados con diabetes mellitus gestacional (12 controlados por dieta, 8 controlado por insulina) y comparados con un grupo control. Las muestras de tejido fueron procesadas y analizadas. La placenta de los embarazos diabéticos no mostró ninguna anormalidad macroscópica, pero el examen por microscopía de luz reveló lesiones como nudos sinciciales, necrosis fibrinoide, edema velloso, fibrosis de las vellosidades y proliferación capilar. La microscopía electrónica de transmisión (TEM) mostró cambios en casi todas las capas de la membrana sincitiotrofoblástica, es decir, la placenta, citotrofoblasto, membrana basal trofoblástica y capilares fetales. Estos cambios se observaron en la placenta de ambos grupos de pacientes donde el nivel de azúcar en la sangre se controló mediante dieta o insulina, pero en grado diferente. Esto indica que el control de la hiperglicemia sólo impide parcialmente el desarrollo de anormalidades en la placenta, las cuales deben ser causadas por algún otro factor constituyente del estado diabético.

Cellular changes in the placenta in pregnancies complicated with diabetes / Cambios celulares en la placenta en embarazos complicados con diabetes

Placenta is the most accurate record of the infant prenatal experience. After delivery if the placenta is examined minutely, it provides much insight into the prenatal health of the baby and the mother. In diabetic pregnancy, placental weight is higher in comparison to normal pregnancy. To study the cellular differences that might contribute to larger size of placenta, light microscopic analysis was performed on 25 full term placentas, out of which 20 were of Gestational diabetes mellitus (12 controlled on diet, 8 controlled on insulin) and 5 control group. Tissue sections were processed and analyzed. Birth weight of neonate, placental weight, vascular pattern of chorionic blood vessels and site of attachment of umbilical cord were recorded. In the placenta of diabetic pregnants, gross abnormalities were uncommon but microscopic examination exhibited, to a varying degree, lesions like syncytial knots, fibrinoid necrosis, villous edema, villous fibrosis and capillary proliferation. These findings indicate that control of hyperglycemia only partially prevents the development of placental abnormalities which must be due to some other constituent factor of diabetic state.

La placenta es el registro más preciso de la experiencia prenatal infantil. Después del parto, si la placenta se examina minuciosamente, esta proporciona una visión de la salud prenatal del bebé y la madre. En el embarazo con diabetes, el peso de la placenta es mayor en comparación con el embarazo normal. Para estudiar las diferencias celulares que podrían contribuir al mayor tamaño de la placenta, se realizó el análisis en microscópico de luz en 25 placentas de término, de las cuales 20 fueron diabetes mellitus gestacional (12 controladas por dieta, 8 controlodas por insulina) y 5 del grupo control. Los cortes fueron procesados y analizados. El peso al nacer de los recién nacidos, el peso de la placenta, el patrón vascular de los vasos sanguíneos coriónicos y el lugar de inserción del cordón umbilical fueron registrados. En la placenta de las embarazadas con diabetes, alteraciones graves fueron poco frecuentes, pero el exámen microscópico mostró, en grado variable, lesiones como nudos sincisiales, necrosis fibrinoide, edema de las vellosidades, vellosidades fibrosas y proliferación capilar. Estos resultados indican que el control de la hiperglucemia sólo en parte impide el desarrollo de anormalidades de la placenta las cuales deben producirce por algún otro factor constituyente del estado diabético.

Double plantaris muscle: a cadaveric study with clinical importance / Músculo Plantar Doble: un estudio en cadáver y su importancia clínica

Los músculos gastronecmio, plantar y sóleo pertenecen al grupo de músculos flexores del compartimiento posterior de la pierna. El músculo plantar es reponsable de la flexión plantar del pie. El músculo es un vestigio en el humano y tiene gran importancia clínica. Se sabe que el músculo plantar tiene muchas variaciones, pero hay pocos repórters sobre la existencia de músculos plantares dobles. El presente trabajo describe un músculo plantar doble en ambos lados, presente en un cadáver, encontrado durante una disección de rutina. El conocimiento del músculo plantar, ya sea normal como de sus variaciones anatómicas, son importantes para el cirujano cuando éste transfiere tendones y para el clínico en el diagnóstico de ruptura muscular.

The gastrocnemius, plantaris and the soleus muscles, comprise the posterior (flexor) compartment muscles of the leg. The plantaris muscle is responsible for causing plantar flexion of the foot. The muscle is vestigial in human beings and has much clinical importance. The muscle is known to exhibit variations but there are few reports on the existence of double plantaris muscle. The present case report describes double plantaris on both sides of a cadaver, which was detected during routine dissection. Knowledge of both normal and abnormal anatomy of the plantaris muscle is important for surgeons performing tendon transfer operations and clinicians diagnosing muscle tears.

Unusual organization of the ansa cervicalis: a case report

The superior root of the ansa cervicalis is formed by C1 fibers carried by the hypoglossal nerve, whereas the inferior root is contributed by C2 and C3 nerves. We report a rare finding in a 40-year-old male cadaver in which the vagus nerve fused with the hypoglossal nerve immediately after its exit from the skull on the left side. The vagus nerve supplied branches to the sternohyoid, sternothyroid and superior belly of the omohyoid muscles and also contributed to the formation of the superior root of the ansa cervicalis. In this arrangement, paralysis of the infrahyoid muscles may result following lesion of the vagus nerve anywhere in the neck. The cervical location of the vagus nerve was anterior to the common carotid artery within the carotid sheath. This case report may be of clinical interest to surgeons who perform laryngeal reinnervation and neurologists who diagnose nerve disorders.

Dorsal Digital Branch of the Thumb: An Anatomical Study / Nervio Digital Dorsal del Pulgar: Estudio Anatómico

The level of origin of digital branch to thumb (DBT) of superficial branch of radial nerve (SBRN) and its relationship to brachioradialis muscle tendon (BRT) and its fascial sheath (FS) were studied on both sides of upper extremities of 50 cadavers (n=100). The DBT of SBRN originated in the middle third of forearm in 3 cases (3%), distal third of forearm in 10 cases (10%) and in wrist and dorsum of hand in 87 cases (87%). All cases having origin in the middle third of forearm and half of the cases having origin in the distal third of forearm were closely related to BRT or its FS. The clinical importance of the study lies in the fact that the DBT supplies dorsum of the thumb and first web space which has least cutaneous overlapping. Any injury or entrapment of this nerve may lead to painful neuritis. Anatomical knowledge of such variations are important for neurologists and surgeons performing operative procedures in Quervain's release, arthroscopy and Wartenberg's disease.

Fue estudiado en los miembros superiores de 50 cadáveres, el origen del nervio digital dorsal para el pulgar (NDDP) desde el ramo superficial del nervio radial (RSNR) y sus relaciones con el tendón del músculo braquiorradial (TMB) y su vaina fascial (VF). El NDDP del RSNR se originó en el tercio medio del antebrazo en 3 casos (3%), en el tercio distal del antebrazo en 10 casos (10%) y en la muñeca y dorso de la mano en 87 casos (87%). En todos los casos en que el NDDP se originaba en el tercio medio del antebrazo y en la mitad de los casos en que se originaba en el tercio distal del antebrazo, tenía relaciones estrechas con el TMB o su VF. La importancia clínica de este estudio se basa en que el NDDP suple el dorso del pulgar y primer espacio interdigital, el cual tiene pequeñísima superposición cutánea. Alguna herida o compresión de este nervio puede llevar a neuritis dolorosa. El conocimiento anatómico de estas variaciones son importantes para neurólogos y cirujanos durante los procedimientos de liberación de Quervain, artroscopía y enfermedad de Wartenberg.