Extension of cardiopulmonary bypass outside the operating room as a short-term bridge to recovery "the poor man's ECMO".

This report describes the use of conventional cardiopulmonary bypass (CPB) circuit beyond the operating room to the critical care unit to provide cardiopulmonary support for patients requiring emergent resuscitation as well as short-term support for rest and recovery of the heart. We modified the CPB circuit and created a closed extra corporeal membrane oxygenation (ECMO) circuit using a conventional oxygenator excluding the venous reservoir. We believe that this technique provides a short-term mechanical support and also acts as a bridge to recovery, or a bridge to decision, in very limited resource settings.

Clinical importance of tensor fasciae suralis arising from linea aspera along with short head of biceps femoris: a rare anomaly.

Tensor fasciae suralis, also known as ischioaponeuroticus is a clinically relevant muscle variant located in the popliteal fossa. Though rare, when present the muscle may arise from any of the hamstrings and gets inserted to the crural fascia of leg or tendocalcaneus and is innervated by the tibial component of sciatic nerve. Here we report a variant of tensor fasciae suralis originated from the lowermost part of linea aspera along with the fibers of short head of biceps femoris in the left lower limb of a male cadaver aged approximately 58 years. The muscle was 16 cm in length and 1 cm breadth in its widest part. It was found inserted to the crural fascia over the lateral head of gastrocnemius and was found innervated by common peroneal nerve. To the best of our knowledge, the tensor fascia suralis muscle originated from linea aspera along with short head of biceps femoris and innervated by common peroneal nerve has not been reported in either cadaveric or imaging studies.

Surgical and radiological importance of a rare cysto-duodeno-colic peritoneal fold.

It is quite common to see abnormal peritoneal folds in the abdominal cavity. Some of them might compress or strangulate the viscera and others might determine the direction of the flow of peritoneal fluid, pus or blood. Many unusual clinically important peritoneal folds such as Ladd's band, cysto-gastro-colic fold, omento-cystic fold, and cysto-colic fold have been reported earlier. Knowledge of these folds is important for radiologists, gastroenterologists, and surgeons. We report an unusual cysto-duodeno-colic fold observed during our dissection classes. The fold was seen to compress the duodenum and colon. The fold extended from the descending part of the duodenum and the transverse colon to the gallbladder. It enclosed the entire gallbladder. A case similar to this has not been reported yet. It is important for the gastroenterologists and laparoscopic surgeons to be aware of this fold to avoid misdiagnosis and iatrogenic injuries.

Accessory Grooves on the Diaphragmatic Surface of the Liver: A Cadaveric Study.

INTRODUCTION: Usually liver does not possess any grooves on its diaphragmatic surface, but there are reports on the presence of grooves on this surface. AIM: The present study was conducted to study the gross features of diaphragmatic surface of the liver and document the presence of any grooves on it and also to correlate our study with the previous studies. MATERIALS AND METHODS: Ninety seven formalin embalmed livers stored in 10% formaldehyde were observed for the presence of grooves on diaphragmatic surface. RESULTS: Fifteen (15.46%) livers had at least one groove on the diaphragmatic surface. Left lobe did not reveal the presence of any abnormal grooves. Presence of a single groove was observed in six (6.18%) livers; Double grooves were found in five (5.15%) livers; Triple grooves were found in three (3.09%) livers and four grooves were found in one (1.03%) liver. The deepest among all the grooves was measured 1.5 cm. CONCLUSION: The knowledge of these grooves is of importance to radiologists and surgeons during their routine procedures.

A strange case of superior mesenteric venous collar around the superior mesenteric artery.

During our dissection classes, we saw a venous collar formed around the superior mesenteric artery (SMA) by the jejunal tributaries of superior mesenteric vein in an adult male cadaver. The jejunal tributaries united themselves to form two common jejunal veins. Upper common jejunal vein crossed superficial to SMA and opened into the SMV in front of the uncinate process of pancreas. The inferior common jejunal vein crossed behind the SMA from left to right and opened into the SMV, 4 cm below this level. A communicating vein connected the two common jejunal veins with each other.

Student Project in Anatomy (SPA) - Making the First Year Medical Students Responsible and Creative.

INTRODUCTION: Creativity is a combination of ones' capacity to think outside the box, the gained knowledge and the passion for creating something. It very easily and effectively provides the creator a chance to be responsible for his/her creation and acts as a confidence booster for him/her. Creativity is inherent, but needs to be polished and nurtured. If nurtured well through proper motivation, the creator excels leaps and bounds. It develops an empathetic behaviour in the creator, when he allows his creations to be used by others. AIM: The study was done to generate learning resources through academically good students and make them available for the entire class. MATERIALS AND METHODS: Academically, top 16 students were involved in a project of their choice. The projects included preparation of question answers, powerpoint presentations, cross-word puzzles, videos, models, atlases and wall hangers etc., ten weeks were given to finish the project. The project was guided and monitored by teachers. The end product of the project was given to the entire class for use. The perception of users of the end products of the projects was recorded through mini interviews. RESULTS: All the students who took part in the project liked working on the project. They felt motivated, rewarded and had mastery on the topic which they used in the project. The students who did not do the project but used the end product of the project also liked the project work. They felt that the end products of the projects were simple, informative and creative. CONCLUSION: By participating in Student Project in Anatomy (SPA), the students get to show their total potential through these creative ways. It provides a fresh and welcome change from the common routine followed otherwise in medical schools. The outcome of the projects can help the entire class. This type of projects can be easily tailored into existing curriculum and in disciplines other than anatomy too.

High incidence of persistence of sacral and coccygeal intervertebral discs in South Indians - a cadaveric study.

The sacrum, by virtue of its anatomic location plays a key role in providing stability and strength to the pelvis. Presence of intervertebral discs in sacrum and coccyx is rare. Knowledge of its variations is of utmost importance to surgeons and radiologists. The current study focused on the presence of intervertebral discs between the sacral and coccygeal vertebrae in south Indian cadaveric pelvises. We observed 56 adult pelvises of which, 34 (61%) pelvises showed the presence of intervertebral discs between the sacral vertebrae and between the coccygeal vertebrae, while 22 (39%) pelvises did not have the intervertebral discs either in the sacrum or the coccyx. We also found that most of the specimens had discs between S1 and S2 vertebrae (39%), followed by, between S4 and S5 (18%), between S2-S3 (14%) and least being between S3-S4 (13%). In the coccyx it was found that 7% of pelvises had disc between Co1-Co2, 4% of them had between Co2-Co3 and 4% had between Co3-Co4. Knowledge regarding such anatomic variations in the sacro-coccygeal region is important to note because they require alterations in various instrumentation procedures involving the sacrum.

Le sacrum, en raison de son emplacement anatomique, joue un rôle essentiel pour assurer la stabilité et la force du bassin. La présence de disques intervertébraux dans le sacrum et le coccyx est rare. La connaissance de ses variations est d'une importance capitale pour les chirurgiens et les radiologues. L'étude actuelle a porté sur la présence de disques intervertébraux entre les vertèbres sacrées et coccygiennes sur des bassins cadavériques dans le sud de l'Inde. Nous avons observé 56 bassins adultes, dont 34 (61 %) ont montré la présence de disques intervertébraux entre les vertèbres sacrées et coccygiennes, tandis que 22 (39 %) autres n'avaient pas des disques intervertébraux, dans le sacrum ou le coccyx. Nous avons également constaté que la plupart des spécimens avaient un disque entre les vertèbres S1 et S2 (39 %), 18 % avaient un disque entre les vertèbres S4 et S5, et enfin 14 % entre S3 et S4. Dans le coccyx, on a constaté que 7 % des bassins avaient un disque entre Co1 et Co2, 4 % d'entre eux l'avaient entre Co2 et Co3 et 4 % entre Co3 et Co4. Il est important de noter la connaissance de ces variations anatomiques de la région sacro-coccygienne en raison des modifications nécessaires à apporter aux diverses procédures d'instrumentation impliquant le sacrum.

Lateral pouch appendix associated with retroperitoneal terminal part of the ileum: a potential diagnostic and surgical challenge.

Knowledge of development and various possible positions of the appendix is important in understanding the pathophysiology of appendicitis. In the present case, we report on a lateral pouch type of appendix in a formalin-embalmed male cadaver. The appendix was found to be situated in a space between the caecum and the lateral abdominal wall. A short band of peritoneum extended from the right iliac fossa to the base of the appendix. The terminal part of the ileum was retroperitoneal and it was vertically situated in the right iliac fossa. Both the ileocaecal junction and the base of the appendix were located at the posterolateral wall of the caecum. The mesoappendix was unusual in position, and it extended from the appendix to the anterolateral wall of the caecum and commencement of the ascending colon. Documentation of rare anatomical variants of the appendix may hold significant clinical importance in diagnosis as well as surgical treatment of appendicitis.

Dangerous course and atypical termination of the splenic vein in relation to pancreas--a case report.

CONTEXT: Knowledge of variations of the vessels closely related to the pancreas adds greatly to the success of pancreatic surgery. Splenic vein is one of the vessels that are closely related to the pancreas. Its variations might not only change the haemodynamics in the vein but also cause unexpected bleeding during pancreatic surgery. CASE REPORT: During our dissection classes, we noted the variations in the course and termination of the splenic vein. After emerging from the spleen, it coursed upward and to the right, embedded in a groove on the anterior surface of body of pancreas. After reaching the upper border, it turned downwards and entered the body of the pancreas. After having a downward course in the body of pancreas, it emerged out and united with the superior mesenteric vein at an angle of about 160 degrees to form the portal vein. CONCLUSION: This peculiar course of the vein might predispose it for thrombosis in case of pancreatitis. It can also lead to iatrogenic injuries during pancreatic or splenic surgeries.

Morphological variations of the lungs: a study conducted on Indian cadavers.

Awareness of anatomical variations in lungs is essential during segmental or lobar resections of lungs. We studied the variations of fissures, lobes and hilar structures in 65 right and 73 left isolated lungs from the dissection hall. Horizontal fissure was absent in 3.07% and incomplete in 35.38% of right lungs. Four point six one percentage of right lungs had 3 fissures and 4 lobes. Three point zero seven percentage of right lungs had 3 arteries, 67.69% had 2 arteries, and 29.23% had only one artery in the hilum. Sixty-three point zero seven percentage of right lungs had two veins in the hilum; 32.30% had 3 veins in the hilum; and 4.61% had more than 3 veins in the hilum. Ninety-eight point four six percentage of right lungs showed 2 bronchi in the hilum, and 1.53% of them showed 3 bronchi in the hilum. Two of the right lungs (3.07%) had an artery passing across the oblique fissure. Fifteen point zero six percentage of left lungs showed incomplete oblique fissure and 2.73% showed 2 fissures and 3 lobes. Five point four seven percentage of left lungs showed 2 arteries and 94.52% had only one artery in the hilum. Eighty point eight two percentage of left lungs had two veins in the hilum and 19.17% had 3 veins in the hilum. Twenty-one point nine one percent of left lungs had 2 bronchi and 78.08% had only one bronchus in the hilum. The knowledge of variations in the lobar and hilar anatomy of the lung presented in this study is clinically important while interpreting the radiological images and performing surgical procedures.

A sciatic nerve with three roots and its perforation by the enlarged ischiadic artery.

Knowledge about the variations of the sciatic nerve (SN) is important for many medical science disciplines. Its compression, entrapment or injury of any kind can result in loss of sensation, pain or motor disabilities in the lower limbs. We observed concurrent neurovascular variations in the gluteal region of an adult female cadaver. The SN had three roots as it emerged out of the greater sciatic foramen. The upper root passed above the piriformis; the middle and lower roots passed below the piriformis. The three roots joined to form the SN in the gluteal region. The inferior gluteal artery (IGA) was large, and it passed below the piriformis, between the middle and lower root of the SN. After a tortuous course, this artery continued down as the sciatic/ischiadic artery. The ischiadic artery (IA) was large in size and pierced the SN in the thigh. After piercing the nerve, it terminated by dividing into muscular branches. The inferior gluteal nerve emerged out from the pelvis through the greater sciatic foramen, above the level of the piriformis. The SN in this case was highly predisposed to compression by the piriformis, IGA or IA, which in turn may lead to altered cutaneous sensation or weakness of the muscles.

Unusual branches of femoral artery in the femoral triangle: a case report / Ramas inusuales de la arteria femoral en el triángulo femoral: reporte de caso

Femoral artery is the major artery of the lower limb. It shows some variations in its branching pattern. One of the rare but clinically important variations is the origin of deep circumflex iliac and inferior epigastric arteries from it instead of from external iliac artery. We report here the origin of inferior epigastric and deep circumflex iliac arteries from the femoral artery bilaterally. Both the arteries passed up deep to the inguinal ligament and had a normal course and distribution after crossing the inguinal ligament. Knowledge of these variations is of importance in plastic surgery, anterior approach to the hip joint, draining psoas abscess or reducing a femoral hernia.

La arteria femoral es la principal arteria del miembro inferior. Se observan algunas variaciones en su patrón de ramificación. Una variante rara, pero clínicamente importante es el origen común de las arterias circunfleja iliaca profunda y epigástrica inferior no desde la arteria ilíaca externa. Presentamos el origen bilateral de las arterias epigástricas inferiores y circunfleja ilíaca profunda desde la arteria femoral. Ambas arterias pasaron profundas al ligamento inguinal y tuvieron un curso y distribución normal después de cruzar el ligamento inguinal. El conocimiento de estas variaciones son de importancia en la cirugía plástica, en el acceso anterior a la articulación de la cadera, el drenaje absceso del músculo psoas mayor o para reducir una hernia femoral.

Biomechanics of Climbing Coconut Trees and its Implications in Ankle Foot Morphology- A Video Sequence analysis.

INTRODUCTION: Few studies regarding foot changes and health of professional coconut tree climbers of south India are reported. Medical emergencies are very common, especially due to accidental fall from coconut trees, while on job. Objective of the present study is to analyze the altered biomechanics of lower limb joints used by the coconut tree climbers. METHOD: Videographs of tree climbing each from a total of 30 male volunteers, all between 30-55 years, engaged in coconut tree climbing profession were collected. RESULTS: The data revealed the coconut tree climbers are using abnormal rages of foot and lower limb joint motions. CONCLUSION: This study establishes an occupationally induced form of altered biomechanics, which leads to professional health hazards.

A peculiar liver with surgically and radiologically important variations: a case report.

A peculiar liver was found in an adult male cadaver during a dissection class for undergraduate medical students. The quadrate lobe and fissure for the ligamentum teres were totally absent. Thus, the cystic notch on the inferior border was very broad and deep, and the fundus and body of the gall bladder popped out through this notch. The cystic duct terminated into the right hepatic duct at the porta hepatis instead of terminating into the common hepatic duct. Awareness of variations of the lobes and fissures may minimize a misdiagnosis of liver problems. The aim of the current study was to alert radiologists and surgeons about possible variations in the external appearance and anomalies of the lobes and fissures of the liver.

A strange case of double annular pancreas.

CONTEXT: The pancreas is a soft lobulated gland situated transversely across the upper part of the posterior abdominal wall. Its parts include the head, neck, body and tail. Annular pancreas is a rare condition where the head of the pancreas surrounds the second part of the duodenum like a ring. CASE REPORT: We observed a rare type of double annular pancreas where the uncinate process encircled the third part of the duodenum. A process from the head of the pancreas encircled the junction between the first and second parts of the duodenum incompletely. There was a large artery running along the anterior border of the pancreas. The artery took origin from the superior mesenteric artery. CONCLUSION: This case may be of interest to gastroenterologists and surgeons.

Sessile ileum, subhepatic cecum, and uncinate appendix that might lead to a diagnostic dilemma.

The subhepatic position of the cecum and appendix is a result of embryological reasons. Subhepatic appendicitis can cause diagnostic dilemmas. During the dissection of an adult male cadaver aged approximately 70 years, the subhepatic position of the cecum and appendix was noted. The appendix made a "U"-shaped bend and its tip was located in the paracolic position. The cecum had appendices epiploicae, and the terminal part of the ileum was retroperitoneal and had ascended vertically to the cecum from the right iliac fossa. Functionally, the sessile part of the ileum might restrict its peristaltic movements. The abnormal position of the terminal ileum might be mistaken for an ascending colon during laparoscopic surgery. The subhepatic position of the cecum and appendix might cause confusion in the diagnosis of acute appendicitis because the tenderness in such cases is not located at the McBurney's point.