Introduction: The nutcracker phenomenon (NCP) (or the left renal vein [LRV] entrapment) focuses on the constriction of the LRV. It occurs commonly between the abdominal aorta (AA) and the superior mesenteric artery. The resulting clinical manifestation of this phenomenon is known as the nutcracker syndrome (NCS). Three types of this phenomenon have been reported: anterior, posterior, and mixed. NCP is a rare finding as reported by various authors. The aim of this study is to know the prevalence of NCP in the population of Uttarakhand, India. Methodology: The study was conducted to understand the tributaries of the renal veins and any variations in their pattern via 160-slice computed tomography (CT) angiography. CT angiographies were retrospectively studied to study the renal vasculature. A total of 14 renal veins which included four accessory renal veins (aRVs) (one left and three right) were analyzed from cadaveric dissection and 44 CT films were included (36 males and eight females) with 98 renal veins which included 10 aRVs (three left and seven right). Results: The current study was done on 49 cases (five cadavers and 44 CT angiography), in which a 10.2% prevalence of NCP was recorded. All were variants of mixed types of NCP. Conclusion: Although the NCP and NCS are rare occurrences, it has been determined that it was possibly underdiagnosed due to a lack of the proper advanced imaging and diagnostic modalities. Hence, it led to the undertreatment of the same. With recent development in diagnostic modalities such as multidetector CT, CT angiography, magnetic resonance angiography, etc., there has been a rise in diagnosis of NCP and NCS, thus resulting in increased prevalence.

Background: Development of the human fetal stomach starts at the 4^th week of intrauterine life. The knowledge of histogenesis of the musculature of the stomach is important for understanding, diagnosis, and treatment of gastric adenomyoma, congenital anomalies like congenital hypertrophic pyloric stenosis, and abnormalities in the development of the enteric nervous system. The aim of this study was to find out the histogenesis of the submucosa (SM), muscularis mucosa (MM), and muscularis externa (ME) in the human fetal stomach. Methodology: Sixty-three freshly aborted fetuses which were free from any gross abnormality were collected from the obstetrics and gynecology department and studied for 2 years. The fetuses were dissected, the stomach was removed, and the tissue was processed for a histological study. Staining was done by hematoxylin and eosin, Masson's trichrome, and Van Gieson's stain. Slides were studied under Zeiss branded light microscope using ×10 and ×40 objectives. Results: MM was discontinuous initially and became well defined by 21 weeks in the fundus and body and by the 23^rd week in the pyloric region. The density of collagen fibers increased gradually in SM and was seen in bundles from the 23^rd week onward. The thickness of SM was more than ME till 22 weeks, and after 27 weeks, it was less than that of ME. In the fundus and body of the stomach, till 18 weeks, ME consisted of two layers, with the inner oblique layer being thicker than the circular layer. The circular layer thickened gradually, and the longitudinal layer appeared by the 25^th week. In the pyloric region, initially, there was only a circular layer. The oblique and longitudinal muscle layers appeared at 17–18 weeks and 25^th week, respectively. The thickness of the circular layer was found to be more than that of the body from the 21^st week onward and became much thicker at around the 27^th week. The histological feature of MM, ME, and SM of the stomach resembled an adult pattern by the 28^th week of gestational age. Conclusion: The findings of the present study about the time of appearance and further development of MM and ME and the thickness and formation of SM of the human fetal stomach are quite comprehensive. These findings are expected to aid in the knowledge of histogenesis of the stomach in the human fetuses and help in the diagnosis and treatment of various congenital anomalies and clinical conditions involving gastric connective tissue and musculature.

Background: The uniqueness of the human foot, in performing various functions, is intricately associated with different morphological parameters, and arch height index (AHI) is an important parameter for the same. The measurement of AHI has putative clinical implications in correcting the underlying causative factors, which contribute to foot pain. This study was an attempt to investigate these parameters as a correlation among asymptomatic versus patients complaining of foot pain (due to nontraumatic causes). Methodology: One hundred asymptomatic and 50 symptomatic adults were engaged in the study after taking prior consent. Various measurements (such as foot length, truncated foot length, foot breadth, arch height – [AH], and AHI) were taken in a standing position. In this study values of foot length, truncated foot length, foot breadth, AH and AHI were compared amongst the two groups . Comparison was done with earlier studies. Results: The difference in AH and AHI (P < 0.05) among the asymptomatic versus the foot pain patients, was significant. There was a considerable difference in body weight and Body Mass Index (BMI) affecting AH and AHI. AHI in the case of the symptomatic foot pain adults was 0.18 in both feet, with a standard deviation (SD) of 0.07. Conclusion: The AHI has been considered an essential parameter in defining and identifying the potential structural factors that predispose an individual to injuries of the foot. Our results indicate that the mean AHI in the case of foot pain adults (nontraumatic) was 0.18 in both feet, with an SD of 0.07. This is lower as compared to other studies. This can be attributed to the fact that earlier studies have been done on asymptomatic patients only. The present study was done to correlate between normal asymptomatic versus foot pain patients. There was a significant difference in the AH and AHI between our two study groups.

Background: Cadavers are the mainstay of learning anatomy by dissection. Due to insufficient awareness of body donation, most of the medical institutions are facing a shortage of cadavers. Health-care professionals should have knowledge about the complete process of body donation, so that they can become motivators of organ and body donation. The present study was conducted to determine and compare the awareness, knowledge, and attitude regarding body donation among medical and paramedical students. Methodology: A cross-sectional and comparative study was conducted among 182 medical and 119 paramedical students through a pretested semistructured questionnaire via a Google form. The Chi-square test was used for the estimation of the P value. Results: 96.7% of medical students and 93.2% of paramedical students had heard about the concept of body donation. 31.8%medical and 49.5% of paramedical students (P < 0.00001) knew that body donation and eye donation can be done simultaneously. The cadavers available are not adequate was felt by 45% of medical and 42.8% of paramedical groups. 90.1% of medical and 86.5% of paramedical students opined for the inclusion of a chapter on body donation. The virtual anatomy table cannot be a substitute for body donation was perceived by 78% of medical and 15.1% of paramedical students (P < 000001). 34.6% of medical students and 56.3% of paramedical students have shown their willingness to donate their whole body and eyes. Conclusion: Although medical and paramedical students have heard about the concept of body donation, their awareness, knowledge, and attitude need to be improved.

Background: Cerebral vasculature fenestration is a rare congenital anomaly and is mostly found in association with aneurysms. Fenestration involving anterior communicating artery (ACoA) is rare. The study's objective was to determine ACoA fenestration incidence in Indian population using computed tomography angiography (CTA). Methodology: Datasets of CT cerebral angiography in 105 patients (67 males and 38 females), of average age- 47.96±16.58 years were systematically reviewed for fenestration in ACoA. The cases with aneurysms and infarcts were excluded from the study. Results: The fenestration involving ACoA was seen in 0.95% (1/105). The fenestration was triangular and located in the proximal part of the artery. No other vascular anomaly was observed in ACoA. Conclusion: The incidence of ACoA fenestration is low in Indian population. Knowledge about the variations of cerebral vasculature will be helpful for radiologists and neurovascular surgeons while dealing with cerebrovascular diseases.

Background: Morphological studies have highlighted the roles of the crista terminalis (CT) and musculi pectinati (MP) in the process behind cardiac arrhythmias. It is also intriguing to explore the notion that structural problems with the CT and MP may be the major anomaly in those who have atrial flutter and may also account for the incidence of atrial flutter even in people with atria that appear to be normal. The aim is to study the cumulative arrangement and morphology of CT and MP in the right atrium of formalin-fixed human cadavers. Methodology: Cross-sectional descriptive research was conducted on thirty hearts obtained from formalin-embalmed adult human cadavers of the age range between 25 and 65 years (22 males and 8 females). Anatomical course, arrangements, and variations of CT and MP were observed and noted. Results: After meticulous dissection of formalin-fixed human heart, variations associated with the morphological traits of the MP and taenia sagittalis (TS) were observed and recorded. According to the gross anatomical architecture of CT and associated MP, it was classified into six various patterns. Type 1 (MP oriented nearly 90° to CT) was found to be the most common variant, exhibited by 16 (53%) hearts, Type 2 (MP oriented parallel to CT) was noted in 1 (4%), 7 (22%) shown Type 3 (combination of Type 1 and Type 2), Type 4 (branching of the MP) was noted in 2 (7%), Type 5 (interlacing trabeculation) was seen in 3 (10%), whereas Type 6 (prominent muscular column of MP) was present in 1 (4%) of the heart. In addition, the observation on TS (prominent band of MP, seen emerging from CT) was also classified into three groups – Type A (TS was absent) was noted in 15 (50%) hearts was the most common variant, Type B (single trunk of TS) was present in 3 (10%) and Type C (multiple trunks of TS) in 12 (40%) hearts. Conclusion: Cardiovascular catheterization frequently results in injury to Type 6 MP and Type B/Type C TS, which have a more intricate arrangement of fibers. Henceforth, collectively the incidence of these clinically relevant variants was a little more than 50%.

Background: First cervical vertebra has different anatomical features than other cervical vertebrae. It holds globe of skull and lacks body and spine. It is composed of 2 lateral masses linked by anterior and posterior arches. Posterior atlanto-occipital membrane is attached to posterior arch whose lateral edge sometimes ossifies thus converting groove into canal. Consequently, neurovascular groove gets converted into a bony ring “ponticulus posticus”. It can cause of neck pain and headache. Knowledge of this variation is important during various orthopedic procedures involving atlas including C1 lateral mass screw placement.Congenital defects of atlantal arch a developmental failure of chondrogenesis is a rare anomaly. These defects are a benign variation discovered incidentally. Detection of these anomalies is clinically important as they can cause acute neurologic deficits, which is associated with neck extension. Study was done: To determine the prevalence of Ponticulus Posticus and to report the frequency of various types of congenital malformations of the atlantal arch. Methodology: 250 computerized tomography (CT) head and neck in axial and sagittal sections from Picture Archiving and Communication System (PACS) of Dr RMLIMS, Lucknow was studied as CT is the best method to study the bony landmarks and any anomaly. Prevalence of variations was calculated. Data was analyzed statistically using SPSS version 21 by Chi-square test. Result: Prevalence of ponticulus posticus was 32.4%. Males had higher prevalence (20.4%) than females (12%). Incomplete ponticulus posticus (24.4%) was more than complete variant (8%). There was predominance of left sided ponticulus posticus(12% vs 8.4%) Deficient posterior arch was found in 9(3.6%) cases. 6 were of type A 3 were of type B. Conclusion: This study will help in determining cause of neurological deficit in patients due to presence of above variations.

Background: Dorsalis pedis artery (DPA) is the chief artery of foot. It provides nutrition to the dorsum of the foot. Palpation of DPA is essential for the diagnosis of peripheral vascular diseases. Cutaneous flaps supplied by branches of DPA are used in various reconstruction surgeries. Methodology: 50 meticulously dissected lower limbs of both sides and known sex were observed for morphometry, asymmetry and sexual dimorphism of DPA and its branches. Variations like absent arcuate artery and extra lateral tarsal arteries were looked for. Results: Absent arcuate artery was seen in 12%. Three tarsal metatarsal arteries and two tarsal metatarsal arteries were seen in 4% and 16%, respectively. An extremely rare case of U-shaped loop joining two tarsal metatarsal arteries was seen in two limbs. Conclusion: Rare variations like multiple tarsal arteries joined by U-shaped loop and absent arcuate artery seen in our study are of importance for reconstruction surgeries using DPA flaps.

Background: Haglund's syndrome an important cause of posterior heel pain presents with a prominent bony contour, a retrocalcaneal bursitis or achillis tendinitis these can also occur in isolation hence for the diagnosis of etiology of Haglund's disease certain radiological parameters and soft tissue parameters have been created to evaluate the anatomical variations which will assist in its exact diagnosis. Study aims to distinguish between the bony and soft tissue causes of Haglund's disease radiologically. Methodology: After Institutional ethical committee clearance an observational cross-sectional study was conducted with subjects coming to radiology OPD for X-ray foot with complains of posterior heel pain fulfilling inclusion and exclusion criteria were examined for X-ray lateral view of foot. Parameters like calcaneal inclination angle (CIA), Fowler Philip angle (FPA), parallel pitch line (PPL), Steffenson & Evenson angle (SEA) measured, posterior/calcaneal spur and posterior calcaneal step were noted. The data obtained was analyzed for mean, Standard deviation, sensitivity % and false negative %. Result: Sensitivity of the parameters were analyzed to find CIA, SEA &PPL to be 63.3%, 55% and 55% sensitive respectively. CIA could be assigned most sensitive but regarding soft tissue parameters none were sensitive. Conclusion: CIA, SEA & PPL were found to be sensitive among bony parameters. But none of the soft tissue parameters were sensitive radiologically highlighting a need for its correlation with clinical symptom in peripheral health centers where MRI is not available. Sensitivity of bony and soft tissue parameters were analyzed to find CIA, SEA & PPL to be sensitive. CIA could be assigned most sensitive among bony parameter but with regards to soft tissue parameters none were sensitive.

Not just anatomists but also clinicians from a variety of disciplines, including orthopedic doctors, surgeons, neurologists, and neurosurgeons, are interested in vertebral abnormalities. Numerous morphological anomalies, such as spinal synostosis, occipitalization, sacralization, and lumbarization, as well as the absence of the posterior vertebral arch, have been reported. Sequentially fused vertebral segments might result in spinal fusion, synostosis of the vertebrae, or blocked vertebrae. Movement limitations, early degenerative changes, and accompanying neurological abnormalities may all be brought on by the block vertebrae. The fusion may be whole or partial, acquired, or congenital. The cervical, lumbar, and thoracic vertebral levels are the most frequently affected by vertebral fusion, whether it is congenital or acquired. A systemic disorder, known as idiopathic diffuse idiopathic skeletal hyperostosis (DISH), is defined by distinctive ossification patterns that can run over at least three more vertebral levels or four successive vertebrae on their anterolateral aspect. Here, we present a series of spinal synostosis at various levels that were identified in museum specimens from our institution and that were associated with the clinical and developmental importance.

In embryonic life developmental malformation of thoracic veins can lead to anomalies of the Superior vena cava and major thoracic veins like Azygos system. Double superior vena cava and double azygos vein are rare congenital anomaly with the incidence of 0.3%. These types of congenital anomalies may or may not be presented with clinical symptoms. This case was noted during the routine cadaveric dissection of thoracic region and heart for medical students in department of Anatomy, we found double superior vena cava (persistent left superior vena cava) along with double (paired) azygos vein in a female cadaver. Right superior vena was formed by the union of right subclavian and right internal jugular vein which receives the arch of right azygos before it opened into the right atrium. Left superior vena cava was formed by the union of left subclavian and left internal jugular vein and it also receives the arch of left azygos vein before it entered into the right atrium. In present case coronary sinus was separated from left persistent superior vena cava and it opened in the persistent left superior vena cava. There was no communication between both the superior vena cava. On right side Azygos vein was normal and open into right superior vena cava. On the left side hemiazygos was in continuation with the accessory azygos vein and it also forming the arch and opened into persistent left superior vena cava. There were no other congenital anomalies present in the heart. These types of congenital anomalies extremely very rare where the left superior vena cava opens into the right atrium directly and coronary sinus opens in to this left superior vena cava. Majority of such types of cases remain asymptomatic. Some cases may be detected accidently during diagnostic or surgical procedures like cardiac angiography, cardiac catheterization, by- pass and dialysis or during autopsy or institutional cadaveric dissection.

The posterior circumflex humeral artery (PCHA) typically emanates from the axillary artery (AxA) that supplies the shoulder region and surrounding structure. During routine dissection, we noticed that a truncus profundocircumflexus arose as a branch of Brachial Artery distal to teres major (TM), which branches into profunda brachii, besides PCHA. This circumflex humeral artery, winding around the TM muscle, coursed superolaterally and reached the quadrangular space for its usual vascular territory. Adequate awareness of such rare variations observed in the present study is pertinent for physicians for quadrangular space syndrome, radiologists to avert misreading of angiographs, and orthopedics in case of trauma to the axilla, shoulder region, and upper arm or during invasive vascular procedures.

Anatomy reveals the human body and its architecture. Right from the intricate turn of an artery, loop of a duct, fold of the skin to the microscopic change in epithelium are studied through anatomy. These nuances are appreciated in a precise and accurate manner when a scalpel is laid on one's body. Today, learning anatomy complemented with new age techniques, enables us to visualize a structure along with their surrounding environment.