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  Citation statistics : Table of Contents
   2019| January-March  | Volume 8 | Issue 1  
    Online since September 7, 2020

 
 
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ORIGINAL ARTICLES
Cystic artery: An anatomic morphological study and its clinical significance
Roopashree Ramakrishna, Suman Tiwari
January-March 2019, 8(1):10-13
DOI:10.1055/s-0039-1688516  
Background Cystic artery is one of the arteries which is of utmost surgical importance, as it originates from the vast range of blood vessels, associated to the coeliac trunk and superior mesenteric artery and its relation to the biliary ducts is variable. Cystic artery is not only difficult to visualize, but difficult to approach during the surgery. This study was undertaken to study the anatomy of arterial variations of cystic artery in the specimens of liver and gallbladder by exploring the extrahepatic duct system, and in addition the relations of cystic artery in the Calot’s triangle were also studied and observed. Materials and Methods The study was conducted on 50 human liver specimens with intact gallbladder and extrahepatic duct system, collected from the Department of Anatomy over a period of 5 years. The specimens obtained were fixed in 10% formalin and were finely dissected. The specimens were observed for parameters like the origin of the cystic artery, its length and diameter, mode and level of termination, relation to the Calot’s triangle, and the extrahepatic duct system. Results Origin of the cystic artery was normal in 92% of cases and variations were seen in approximately 8% cases. The most common origin of the cystic artery was from the right hepatic artery, which was in 92% of the cases. In the present study, in 97% cases the cystic artery terminated by dividing into the superficial and deep branches. In the rest, the artery continued as a superficial branch, the deep branch being replaced by the accessory cystic artery. In 64% cases, the cystic artery was seen within the Calot’s triangle, and in 36% of cases, it was outside the Calot’s triangle. In 67% cases, the cystic artery was medial to the cystic duct, in approximately 63% cases the cystic artery was lateral to the common hepatic duct, and in 30% of the cases the cystic artery passed anterior to the cystic duct. Incidence of accessory cystic arteries in the present study was approximately 4%.
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Morphological study of anomalous deep extensors of the hand
Gaddam Vijaya Lakshmi, Stelin Agnes Michael
January-March 2019, 8(1):3-9
DOI:10.1055/s-0039-1688509  
Background Anomalous muscles on the dorsum of the hand include the extensor medii proprius (EMP), extensor indicis et medii communis (EIMC), extensor digitorum brevis manus (EDBM), and anomalous extensor indicis proprius (aEIP). They are commonly seen during routine cadaveric dissections and hand surgeries. There are very few studies on them in the recent past. Hence, this study was conducted with the aim of studying their incidence and morphology. Materials and Methods This study was conducted at the Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala, over a period of 15 months, on 80 free upper limbs. Deep extensor muscles of the forearm were dissected. The frequency of the anomalous muscles was noted. Length and width of the muscles and tendons were measured using thread, ruler, and vernier calipers. The median and range were calculated. The musculotendinous (MT) junction of the EIP was observed. It was considered to be aEIP if its MT junction was beyond the distal edge of the extensor retinaculum in wrist flexion. Results EMP was seen in 8.75% of the limbs, with average muscle length and width of 4.53 ± 0.7 cm and 3.7 ± 0.8 mm and average tendon length and width of 9.7 ± 1.2 cm and 1.6 ± 0.8 mm, respectively. Frequency of EIMC was 3.75%, its average muscle length and width being 3.67 ± 1.14 cm and 2.3 ± 0.6 mm and its tendon length and width being 9.8 ± 0.61 cm and 2.0 ± 1.7 mm. Incidence of EDBM was 2.5%; its average muscle length and width being 4.5 ± 0.71 cm and 1.25 ± 0.3 mm and tendon length and width being 3.15 ± 0.91 cm and 3.5 ± 0.7 mm. Frequency of aEIP was observed to be 6.25%. Conclusion Anomalous extensors have a frequency of less than 10%. Tendons of the EMP and EIMC are very thin and asymptomatic. The EDBM belly is distal to the retinaculum and does not cause symptoms, unless hypertrophied. aEIP passes through the narrow compartment and is more likely to cause pain.
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Relevance of learning anatomy to clinical practice: Perceptive of medical students, interns, and clinicians
NA Priyadharshini, V Dinesh Kumar, R Rajprasath, Rema Devi
January-March 2019, 8(1):32-37
DOI:10.1055/s-0039-1688893  
Introduction Anatomy is considered as the cornerstone of medical education and its teaching methodologies are undergoing metamorphosis. Anatomy education is often debated as over teaching of body facts and undertaught clinical facts by modern and traditional anatomy mentors respectively. Equilibrium between this episteme of anatomy education could be achieved after considering the perceptions of anatomy stakeholders. The present study was an initiative of the same. Methodology A quantitative survey was administered among 60 medical students (4th semester), 60 interns, and 30 clinicians (both medical and surgical fields). The completed questionnaires were analyzed and the results were tabulated. Results Though anatomy education is suffocating due to reduction in teaching hours, all the study groups have strongly agreed that cadaver contact is crucial for better understanding of the human body. The perception regarding the importance of anatomy education in clinical practice was statistically significant (p = 0.04) among the study groups. The insight of role of anatomy education in enabling lifelong self-directed learning and inculcating professional skills and ethics of medicine showed significant p value (p = 0.00 and 0.01). Discussion The present study has echoed the perception of anatomy stakeholders. Studies emphasize that revamping of anatomy curricula is needed for the time and that can be made with the inputs from the academic anatomists and clinicians. Clinicians expressed the lag between anatomy teaching and clinical practice. Medical students felt that anatomy education kindled them to develop inquiry-based learning, helped to master radiological images, and improved their teamwork and communication skills.
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PREFACE
President’s message
Gunapriya Raghunath
January-March 2019, 8(1):2-2
DOI:10.1055/s-0039-1688849  
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CASE REPORT
Iniencephaly: A rare anomaly
Shantanu B Chavan
January-March 2019, 8(1):43-46
DOI:10.1055/s-0039-1688530  
Following case report is an attempt to ascertain that the fetus obtained and evaluated presents with iniencephaly, which is one of the rare variants of neural tube defects. Most of the cases of iniencephaly are reported as isolated incidences. However, some researchers have reported its occurrence in cluster, in a short span of time in a specific population. This case report elaborates various gross anomalies in a fetus which differentiates it from other neural tube defects. The study was performed by examining the external features as well as the radiograph of the abortus. The study also elaborates in brief the different versions of neural tube anomalies which are sometimes concomitantly observed in the same fetus. Prenatal or postnatal diagnoses of iniencephaly with or without associated anomalies are suggestive of chromosomal abnormalities and in such cases cytogenetic investigations are highly recommended.
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EDITORIAL
Editor’s note
Ravichandran Doraiswamy
January-March 2019, 8(1):1-1
DOI:10.1055/s-0039-1688848  
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ORIGINAL ARTICLES
A morphological and morphometric study of foramen ovale in dry skulls of Indian population
Gowri Shankar, N Muthukumaravel
January-March 2019, 8(1):38-42
DOI:10.1055/s-0039-1688892  
Background and Aim The foramen ovale is a clinically significant foramen present in the skull base. The mandibular nerve is an important structure traversing this foramen and the trigeminal ganglion is also located just above the foramen ovale in the Meckel’s cave. These two structures are targeted by neurosurgeons and pain physicians in patients with trigeminal neuralgia. Clinical procedures for treating trigeminal neuralgia necessitate very precise knowledge about the foramen ovale. Hence, this study was designed to evaluate the morphology and morphometry of foramen ovale and its variations in dry skulls of India. Materials and Methods This study was conducted in 100 adult dry skulls of either sex. The foramen ovale was assessed for morphology and morphometry bilaterally using digital Vernier calipers. The summary data for all the measurements are presented in this study. The statistical analysis was performed using SPSS version 19. Results The most common shape of the foramen ovale was found to be oval. Oval-shaped foramen ovale was present in 72% (right side) and 68% (left side) of dry skulls that were examined. A mean length of 6.62 ± 1.11 mm (right side) and 6.72 ± 1.08 mm (left side) and width of 3.78 ± 0.89 mm (right side) and 3.89 ± 0.73 mm (left side) were observed. The distance between the foramen ovale and the zygomatic point was 35.65 ± 3.24 mm (right side) and 34.91 ± 2.58 mm (left side). The distance between the zygomatic point and the anterior margin of the external auditory meatus was 21.79 ± 3.25 mm (right side) and 18.62 ± 2.37 mm (left side). Conclusion An in-depth knowledge of the morphology and morphometry which include the different metric and nonmetric parameters and the variations in foramen ovale in dry skulls has been studied, which will be helpful to neurosurgeons and pain physicians to plan their clinical procedures which involve the base of skull.
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Normal anatomy of porta hepatis—A cadaveric study
Dhanalaxmi D Neginhal, Umesh K Kulkarni
January-March 2019, 8(1):22-26
DOI:10.1055/s-0039-1688545  
Background and Aim Porta hepatis (PH) of the liver acts as a gateway for exit and entry of important structures like portal vein, hepatic artery, and hepatic duct. Having knowledge of variations about the dimensions and structures at PH becomes important to avoid complications during surgical and radiological interventions. Our study aims to observe the dimensions of PH and also the number, arrangement, and variations of structures passing through PH. Materials and Methods Fifty adult cadaveric human livers which were preserved in formalin were studied. Transverse diameter, anteroposterior diameter, and circumference of PH were measured using vernier calipers, measuring scale, and thread. PH was carefully dissected to study the number, arrangement, and combination of arteries, veins, and ducts at PH. Results The mean transverse diameter, anteroposterior diameter, and total circumference of PH was 3.17 ± 0.50, 1.68 ± 0.36, and 10.46 ± 1.415 cm, respectively. Eighteen specimens showed presence of two arteries, two veins, and one duct at PH. Maximum number of arteries, veins, and ducts passing through PH were 5, 4, and 1, respectively. The ducts were anterior, arteries in the middle, and veins were posterior in PH of all the livers. Conclusion The variations observed in our study will be of great importance to anatomists, surgeons, and radiologists.
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A study of correlation between anthropometric measurements of fetal limbs and gestational age of the fetus
D Agnihotri, A Dubey, D Singh, SL Jethani
January-March 2019, 8(1):27-31
DOI:10.1055/s-0039-1688546  
Introduction and Aims Determination of fetal age is of importance in the field of embryology and forensic sciences. Various methods and parameters have been used to calculate the same. The aim of the present study was to derive regression equations between anthropometric measurements of limbs of aborted fetuses and the gestational age of the fetuses. Methods The study has been performed on 30 fetuses of gestational age varying from 13 to 32 weeks. The crown–rump length, length of the arm, forearm, hand, thigh, leg, and sole were measured with the help of manual sliding vernier caliper. Regression equations were derived using statistical methods. Results The anthropometric measurements of the limbs showed a strong correlation with the crown–rump length and the gestational age. Conclusions With the correlation demonstrated between anthropometric data and fetal age, and the regression equations derived using these data, would be helpful in determining the age of the fetus without availability of crown–rump length or using only fragments of mortal remains of the fetus.
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Estimation of stature and sex by foot length measurements using linear regression and discriminant function analysis, respectively: A study in central india population
Rekha Lalwani, Himank Gupta, Sunita A Athavale, Sheetal Kotgirwar
January-March 2019, 8(1):14-17
DOI:10.1055/s-0039-1688531  
Background and Aim In forensic investigations establishing the identity of a person is a vital step. Stature and sex are important attributes of personal identity. In cases of mass disasters, generally isolated body parts and extremities are recovered as remains and are utilized to ascertain identity of an individual with personal attributes like gender, stature. The present study was conducted to ascertain if the foot length can be reliably used in estimation of stature and gender, and to establish population-specific regression equation and discriminant function analysis in population of Central India. Methods One hundred subjects (50 males and 50 females) between the age group of 20 and 40 years, who are residents of Central India for two generations, were studied. Foot length, of both right and left sides, was recorded for each individual and stature was measured with the help of a stadiometer. Data were subjected to statistical analysis. Results Statistical analysis of the data of the study population showed statistically highly significant differences (p < 0.001) between males and females. Statistically highly significant positive correlation was observed between stature and foot length in males and females. Linear regression equations for stature estimation were derived separately for males and females. The discriminant function analysis, utilizing foot length correctly, classified 78 to 85.1% of cases for respective gender. Conclusion The statistically significant positive correlation between the foot length and stature and accuracy of sex classification by discriminant function analysis indicate the reliability of foot length in predicting stature and gender of an individual.
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Accuracy of the fetal kidney length measurement by ultrasonography in the determination of the gestational age in pregnancy
Elangovan Muthaian, Karthick Selvaraj
January-March 2019, 8(1):18-21
DOI:10.1055/s-0039-1688532  
Background Definitive calculation of gestational age (GA) forms the basis for rendering standard antenatal care. Depending on the period of pregnancy, various parameters are in use for GA calculation. But none of those fetal biometric indices were observed to be reliable with progression of pregnancy beyond second trimester. Various studies claiming fetal kidney length (FKL) as a reliable index to calculate GA in late trimester have prompted this study to validate and compare this claim with other indices among Indian women in late pregnancy. Materials and Methods This study was done on 100 singleton uncomplicated late pregnant women who knew their last menstrual period definitely. A blinded sonographic process was executed wherein one sonologist measured traditional biometric indices like biparietal diameter, head circumference, abdominal circumference, and femur length and calculated GA. While the other measured only FKL and calculated GA. The results were descriptively analyzed. The correlation of each of the index in accurately calculating GA was done by Pearson’s correlation test. Results FKL was 28.12 mm at 28 weeks and it progressively increased along with GA and it was 40.10 mm at 40 weeks’ gestation. The Pearson’s correlation coefficient of r = 0.926 was observed to be significant compared with other fetal biometric indices measured. Conclusion FKL could be used as a single index to calculate GA in third trimester. Combined with other sonographic fetal indices FKL might increase the accuracy of GA calculation in late pregnancy.
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