Anatomy of left atrioventricular valve (mitral valve) leaflets in adult Indian cadavers / Anatomía de los velos valvulares en la valva atrioventricular izquierda (válvula mitral) en cadáveres indios adultos

The atrioventricular valve is the most commonly repaired valve of the heart. Interventional procedures like annuloplasties, valvotomy/valvuloplasty, repair/replacement of the valve for regurgitation or prolapse are increasing by the day. This necessitates a clear understanding of the mitral valve anatomy. The present study is an attempt to revisit the anatomy of mitral valve. The present study was conducted on 34 adult embalmed heart specimens. Based on the newly defined criteria, observations were made on: 1) Number of commissures and their positions, 2) Number and position of leaflets, 3) Number and position of minor commissures, 4) Annular circumference (AC), 5) Length of annular attachment of each leaflet (LAA), 6) Maximum width of coapted/ folded margin (FM) of the anterior and posterior leaflet, 7) The surface area of each leaflet (SA). The observations were analyzed statistically. The findings of the present study and the subsequent statistical analysis offer a dynamic concept of the anatomy of mitral valve leaflets. It suggests that the valvular anatomy depends upon a complex interplay of various valve components. The extra leaflets tend to occur when annular circumference increases and is not appropriately compensated by various valvular elements. The different methodology adopted in the present study and the interpretations deduced hereupon, shall dispel the existing ambiguities in the description of the leaflets and improve our understanding of the structure and function of the mitral valve complex.

La valva atrioventricular es la valva más comúnmente reparada del corazón. Los procedimientos intervencionistas como anuloplastías, valvotomía/valvoplastía, reparación/reemplazo de la valva por la regurgitación o prolapso están aumentando día a día. Para ello, se requiere una clara comprensión de la anatomía de la valva atrioventricular. El presente estudio intenta volver a examinar la anatomía de la valva atrioventricular. Se estudiaron 34 corazones de adultos embalsamados. Sobre la base de los criterios definidos, se realizaron las siguientes observaciones: 1) número de comisuras y sus posiciones, 2) número y localización de los velos, 3) número y localización de las comisuras menores, 4) circunferencia anular (AC), 5) longitud de la unión anular de cada valva (LAA), 6) ancho máximo del margen de coaptación/margen velar (FM) de los velos anterior y posterior y 7) área de superficie de cada valva (SA). Las observaciones fueron analizadas estadísticamente. Los resultados del presente estudio y el análisis estadístico ofrecen un concepto dinámico de la anatomía de la valva atrioventricular. Se sugiere que la anatomía de las valvas depende de una interacción compleja de varios de sus componentes. Los velos adicionales tienden a aparecer cuando aumenta la circunferencia anulares y no se compensa adecuadamente por diversos elementos valvares. La diferente metodología adoptada en el presente estudio sus interpretaciones, podrían disipar ambigüedades existentes en la descripción de las valvas y mejorar nuestra comprensión de la estructura y función del complejo de la valva atrioventricular.

The thyroid gland and its variations: a cadaveric study.

The size and shape of the thyroid gland is subject to much variation, as stated by Wood Jones. Literature is replete with a large number of variations of the gland. By utilizing various techniques like gross dissection, histology, developmental anatomy, and recently thyroid scans and scintigraphy, some common and certain rare anomalies of the thyroid with their possible developmental bases are described in the literature. An attempt has been made to study the thyroid glands in 90 male cadavers available in our department, with ages ranging from 60 to 75 years with mean height of 5'4". The parameters that were observed included the length and width of lobes, presence or absence of pyramidal lobe, levator glandulae thyroideae, and isthmus with its relation to the tracheal rings. The average length of the right lobe was 4.32 cm, and the left lobe was 4.22 cm. The thickness of the right lobe was 1.13 cm, and the left lobe was 1.18 cm. Pyramidal lobe was present in 34 (37.77%) cases, frequently arising from the left lobe, while the levator glandulae thyroideae was present in 27 (30%) instances, mostly attached superiorly to the body of the hyoid bone. The isthmus was absent in 15 (16.66%) cases; its relation with the tracheal rings greatly varied from the cricoid cartilage to the fourth tracheal ring. Knowledge of variations of the thyroid assumes significance as this has relevance in the resection of thyroid, tumours, and tracheostomy.

Some interesting observations on the surface features of the liver and their clinical implications.

INTRODUCTION: A sound knowledge of the normal and variant liver anatomy is a prerequisite to having a favourable surgical outcome. Knowledge of the commonly-occurring variations assumes even more significance in the era of diagnostic imaging and minimally-invasive surgical approaches. Although the segmental anatomy of the liver has been extensively researched, very few studies have dealt with the surface variations of the liver. METHODS: 90 formalin-fixed livers were utilised for the study. Variations regarding the shapes of the caudate and the quadrate lobes as well as the normal fissures were observed. The presence of the accessory fissures and any other variations on the surface of the livers were noted. RESULTS: Varied shapes of the caudate and the quadrate lobes were encountered. Notching along the inferior border of the caudate lobe was seen in 18 percent of livers, a vertical fissure was observed in 30 percent, and prominent papillary process was seen in 32 percent. Accessory fissures and grooves were more common in the right lobe. Multiple prominent vertical grooves were observed on the anterosuperior surface of the liver in six percent of livers. Quadrate lobe was absent in four percent, and in two cases, it was found to be deeply buried. Presence of a pons hepatis, bridging the left and the quadrate lobes, was observed in 30 percent of the livers examined. CONCLUSION: Our study is expected to serve as a guide for proper interpretations of liver images using various imaging modalities. It will also be useful to the operating surgeons to be aware of the frequently-occurring morphological variations on the liver surface.

Morphology of peroneus tertius muscle.

Peroneus tertius (PT) muscle is peculiar to man, and man is the only member among the primates in whom this muscle occurs. The muscle is variable in its development and attachment. Because of functional demands of bipedal gait and plantigrade foot, part of extensor digitorum brevis (EDB) has migrated upwards into the leg from the dorsum of foot. PT is a muscle that evolution is rendering more important. In a total of 110 cadavers, extensor compartment of leg and dorsum of foot were dissected in both the lower limbs and extensor digitorum longus (EDL), and PT muscles were dissected and displayed. PT was found to be absent in 10.5% limbs, the incidence being greater on the right side. The remaining limbs in which the PT muscle was present had a very extensive origin from lower 3/4th of extensor surface of fibula (20% on right and in 17% on left), and the EDL was very much reduced in size. In approximately 12%, the tendon of PT was thick or even thicker than the tendon of EDL. In 4%, the tendon extended beyond fifth metatarsal up to metatarsophalangeal joint of fifth toe, and in 1.5%, it extended up to the proximal phalanx of little toe. In two cases (both on the right side), where PT was absent, it was replaced by a slip from lateral margin of EDL. We conclude that PT, which is preeminently human, is extending its purchase both proximally and distally.

Mucormycosis: A retrospective study.

A retrospective study has been carried out in a hospital over the past 5 years on 13 patients of mucormycosis. The study included evaluating the etiology, pathology, clinical features, management, and complications of mucormycosis. The results and conclusions have been studied and summarised in our paper.