Case report of high origin of radial, ulnar, and profunda brachii arteries, its clinical implications and review of the literature / Relato de caso de origem alta das artérias radial, ulnar e braquial profunda, suas implicações clínicas e revisão de literatura

Arterial variations in the arm are of potential clinical implications as it is a frequent site of injury and also involved in many surgical and invasive procedures. During a dissection of the right upper extremity, an abnormal high origin of the radial and ulnar arteries was found. The brachial artery had a very short segment without any branches, divided into the radial and ulnar arteries at the upper third of the arm. The course and branching pattern of these radial and ulnar arteries in the arm are discussed. It was also observed that the profunda brachii artery was represented by two separate branches arising from the posterior circumflex humeral artery. Accurate knowledge of these variation patterns is of considerable clinical importance in the conduct of reparative surgeries around the shoulder and fracture management of the humerus. These additional data of arterial anomalies to contemporary anatomical literature are of interest to clinicians, in particular vascular and plastic surgeons and radiologists.

As variações arteriais no braço têm potenciais implicações clínicas já que o braço é um sítio de lesões frequentes, além de estar envolvido em muitos procedimentos cirúrgicos e invasivos. Durante a dissecção da extremidade superior direita, uma origem alta anormal das artérias radial e ulnar foi encontrada. A artéria braquial apresentava um segmento muito curto sem quaisquer ramos, dividindo-se nas artérias radial e ulnar no terço superior do braço. O curso e o padrão de ramificação das artérias radial e ulnar no braço são discutidos. Também se observou que a artéria braquial profunda estava representada por dois ramos separados, surgindo da artéria umeral circunflexa posterior. O conhecimento preciso sobre esses padrões de variação é de considerável importância na realização de cirurgias reparadoras na região do ombro e no manejo de fraturas de úmero. Estes dados adicionais sobre as anomalias arteriais para a literatura anatômica contemporânea são de grande interesse para os médicos, especialmente para cirurgiões plásticos e vasculares e radiologistas.

Abnormal branching of the axillary artery: subscapular common trunk: a case report

An unusual unilateral variation in the branching pattern of axillary artery was observed in a 60 year old female embalmed cadaver. The axillary artery had only two branches arising from its proximal (first) part and no branches from its remaining distal (second & third) parts. The branches are superior thoracic (usual) and another large collateral (unusual) branch. This collateral branch is the origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. We propose to name this artery as common subscapular trunk. The course of this collateral artery (common subscapular trunk) and its branches and also clinical significance of this variation are discussed in the paper.

Una inusual variación unilateral en el patrón de ramificación de la arteria axilar se observó en un cadáver embalsamado de 60 años de edad. La arteria axilar tuvo sólo dos ramas derivadas de su parte proximal (primera) y no otorgó ramas de su parte distal (segunda y tercera). Las ramas son superiores torácica (habitual) y otra gran rama colateral (inusual). Esta rama colateral es el origen de varias arterias importantes como la circunfleja escapular, toracodorsal, circunfleja humeral posterior, taraco-acromial y torácica lateral. Proponemos el nombre variación arterial como tronco común subescapular. El curso de este tronco común subescapular y sus ramas y también el significado clínico de esta variación son discutidas en este trabajo.

Anatomical variation of radial wrist extensor muscles: a study in cadavers

OBJECTIVE: The tendons of the extensor carpi radialis longus and brevis muscles are quite useful in tendon transfer, such as in correction of finger clawing and restoration of thumb opposition. Knowledge of additional radial wrist extensor muscle bellies with independent tendons is useful in the above-mentioned surgical procedures. METHODS: The skin, subcutaneous tissue, and antebrachial fascia of 48 (24 on the right side and 24 on left side) male upper limb forearms were dissected. The following aspects were then analyzed: (a) the presence of additional muscle bellies of radial wrist extensors, (b) the origin and insertion of the additional muscle, and (c) measurements of the muscle bellies and their tendons. RESULTS: Five out of 48 upper limbs (10.41 percent) had additional radial wrist extensors; this occurred in 3 out of 24 left upper limbs (12.5 percent) and 2 out of 24 right upper limbs (8.3 percent). In one of the right upper limbs, two additional muscles were found. The length and width of each additional muscle belly and its tendon ranged between 2 - 15cm by 0.35 - 6.4cm and 2.8 - 20.8cm by 0.2 0.5cm, respectively. The additional radial wrist extensor tendons in our study basically originated either from the extensor carpi radialis longus or brevis muscles and were inserted at the base of the 2nd or 3rd metacarpal bone. CONCLUSION: The present study will inform surgeons about the different varieties of additional radial wrist extensors and the frequency of their occurrence.

A comparison of vitamin A and leucovorin for the prevention of methotrexate-induced micronuclei production in rat bone marrow

INTRODUCTION: Methotrexate, a folate antagonist, is a mainstay treatment for childhood acute lymphoblastic leukemia. It is also widely used in a low dose formulation to treat patients with rheumatoid arthritis. In rats, methotrexate is known to induce micronuclei formation, leading to genetic damage, while vitamin A is known to protect against such methotrexate-induced genetic damage. Leucovorin (folinic acid) is generally administered with methotrexate to decrease methotrexate-induced toxicity. OBJECTIVES: We aimed to determine whether vitamin A and leucovorin differed in their capacity to prevent formation of methotrexate-induced micronuclei in rat bone marrow erythrocytes. The present study also aimed to evaluate the effect of combined treatment with vitamin A and leucovorin on the formation of methotrexate-induced micronuclei. METHODS: Male and female Wistar rats (n=8) were injected with 20 mg/kg methotrexate (single i.p. dose). The control group received an equal volume of distilled water. The third and fourth groups of rats received vitamin A (5000 IU daily dose for 4 successive days) and leucovorin (0.5 mg/kg i.p. dose for 4 successive days), respectively. The fifth and sixth groups of rats received a combination of vitamin A and a single dose of methotrexate and a combination of leucovorin and methotrexate, respectively. The last group of rats received a combination of leucovorin, vitamin A and single dose of methotrexate. Samples were collected at 24 hours after the last dose of the treatment into 5 percent bovine albumin. Smears were obtained and stained with May-Grunwald and Giemsa. One thousand polychromatic erythrocytes were counted per animal for the presence of micronuclei and the percentage of polychromatic erythrocyte was determined. RESULTS: Comparison of methotrexate-treated rats with the control group showed a significant increase in the percentage of cells with micronuclei and a significant decrease polychromatic...

The origin of the inferior phrenic artery: a study in 32 South Indian cadavers with a review of the literature

BACKGROUND: Considering the paucity of information presently available concerning inferior phrenic arteries, a more definitive study seemed appropriate and necessary, both for its potential clinical applications and to provide additional data to contemporary anatomical literature. OBJECTIVE: Most anatomical textbooks of gross anatomy offer very little information concerning the anatomy and distribution of the inferior phrenic artery (IPA). For that reason, the origin of the IPA has been studied and the available literature has been reviewed. METHODS: Thirty-two human adult cadavers preserved in formalin obtained from the departments of Anatomy, Kasturba Medical College, Manipal and Mangalore were dissected and the origin of the IPA was studied. RESULTS: The IPA had its usual origin from the abdominal aorta in 28 cases but in the remaining four cases, two were arising from the celiac trunk, one from the left gastric artery and one from the right renal artery. CONCLUSION: The IPA usually originates from the aorta or celiac artery, and less frequently from the renal, hepatic or left gastric arteries. The IPA is a major source of collateral or parasitized arterial supply to hepatocellular carcinoma, second only to the hepatic artery. Literature on the IPA origin and clinical implications of variation in its origin have been reviewed in this article.

CONTEXTO: Considerando a escassez de informações atualmente disponíveis sobre artérias frênicas inferiores, umestudo mais definitivo nos pareceu apropriado e necessário, tanto por suas potenciais aplicações clínicas quanto para fornecer dados adicionais à literatura anatômica contemporânea. OBJETIVO: A maioria dos livros-texto de anatomia oferece muito poucas informações referentes à anatomia e distribuição da artéria frênica inferior (AFI). Por este motivo, a origem da AFI foi investigada e a literatura disponível foi revisada. MÉTODOS: Trinta e dois cadáveres humanos adultos preservados em formol e obtidos dos departamentos de anatomia do Kasturba Medical College, Manipal and Mangalore foram dissecados, e a origem da AFI foi investigada. RESULTADOS: A AFI teve sua origem habitual na aorta abdominal em 28 casos; no entanto, nos quatro casos restantes, duas originavam-se do tronco celíaco, uma da artéria gástrica esquerda e uma da artéria renal direita. CONCLUSÃO: A AFI geralmente origina-se da aorta ou artéria celíaca, e menos freqüentemente das artérias renal, hepática ou gástrica esquerda. A AFI é a maior fonte de fornecimento arterial colateral ou parasitado para carcinoma hepatocelular, ficando atrás somente da artéria hepática. A literatura sobre a origem da AFI e as implicações clínicas de variação em sua origem foram revisadas neste artigo.

Meckel's Diverticulum: A Case Report / Divertículo de Meckel: Reporte de Caso

Meckel's diverticulum is the most prevalent congenital anomaly of the gastrointestinal tract. It might remain completely asymptomatic or may mimic some disorders like Crohn's disease, Appendicitis and peptic ulcer diseases. A Meckel's diverticulum was found during routine dissection. A brief review of this anomaly, its embryological explanation, and probable clinical implications with its management is discussed in this report.

El diverticulo de Meckel es la anomalía congénita más prevalente del tracto gastrointestinal. Puede ser un remanente totalmente asintomático o puede provocar algunos desórdenes como la enfermedades de Crohn, apendicitis y úlcera péptica. Un diverticulo de Meckel fue encontrado durante una disección de rutina. Una breve revisión de esta anomalía, su explicación embriológica y probables implicaciones clínicas fueron discutidas en este trabajo.

Estudio piloto del ángulo y rama de la mandíbula en la población hindú / A pilot study of the mandibular angle and ramus in indian population

To evaluate the mandibular angle and to analyze the relationship of the angle and height & breadth of the ramus of the mandible to the gender, so as to study its role in the anthropological diagnosis. The angle, height and breadth of the ramus of adult dry human mandibles of both sexes were measured using a goniometer. The values obtained were analyzed statistically. The present study showed a statistically significant difference in the mandibular angle as well as height of the ramus between both the sexes. The mean mandibular angle of Indian population when compared to that of European population was found to be lower by 9 degrees. The findings of this study might be useful in providing anthropological data that can also be used in dental and medical practice. However, the Indian mandible can be used for sexual dimorphism as is usual in anthropological work; it appears to possess important unfavourable anatomic factors that may predispose the individuals to difficult laryngoscopy or intubation.

Para estudiar su rol en el diagnóstico antropológico, evaluamos el ángulo de la mandíbula y analizamos las relaciones de este ángulo con la altura y ancho de la rama de la mandíbula, en ambos sexos. Con un goniómetro, en huesos secos, fue obtenido el ángulo, alto y ancho de las mandíbulas humanas. Los valores obtenidos fueron analizados estadísticamente. El estudio mostró diferencias estadísticamente significativas en el ángulo mandibular como también en la altura de la rama de la mandíbula, en ambos sexos. La media del ángulo mandibular de la población hindú fue 9 grados menor, comparada con la población europea. Los resultados de este estudio pueden ser útiles al aportar datos antropológicos utilizados en las prácticas médica y dental. Por otra parte, la mandíbula de los hindúes puede ser usada como dimorfismo sexual como es usual en trabajos antropológicos. Parece haber factores anatómicos desfavorabes importantes que pueden predisponer a los individuos a laringoscopías difíciles o intubación.

A Variation of Phrenic Nerve: Case Report and Review / Una Variación del Nervio Frénico: Reporte de Caso y Revisión

During routine dissection in the Department of Anatomy following anatomical variations of phrenic nerve were observed on right side in the neck region of a middle aged cadaver. The phrenic nerve in its early course close to its origin was giving a communicating branch to C5 root of brachial plexus and at the level of the root of neck just before entering the thorax, the phrenic nerve was placed anterior to the subclavian vein. This unique case of phrenic nerve variation gains tremendous importance in context of subclavian vein cannulation, implanted venous access portals, and supraclavicular nerve block for regional anesthesia.

Durante una disección de rutina en el Departamento de Anatomía, observamos una variación anatómica del nervio frénico en el lado derecho del cuello de un cadáver de mediana edad. El nervio frénico cercano próximo a su origen dio un ramo comunicante para la raíz C5 del plexo braquial. A nivel de la raíz del cuello, justo antes de entrar al tórax, el nervio frénico se colocaba anterior a la vena subclavia. Este caso único de variación del nervio frénico adquiere una gran importancia en caso de canulación de la vena subclavia, implantes venosos accesos portales, y bloqueo del nervio supraclavicular por anestesia regional.