Indian Journal of Anatomy

Rectus sternalis is a strap muscle occasionally present in anterior thoracic wall. Rectus sternalis if present, can be used in breast reconstruction surgeries after mastectomy in association with pectorals and also in head and neck reconstructive surgery. During routine dissection for the undergraduates on the anterior thoracic wall, unilateral presence of rectus sternalis muscle was found on right side of the chest. The muscle was extending from 5th rib on the right side (3.6 cm away from sternum) to sternum (at the level of manubriosternal junction). The muscle was 7.2 cm long and 0.8 cm broad in the middle part of the muscle. Both attachments were tendinous. This strap like muscle was seen running between superficial fascia and pectoral fascia of the chest. It may cause confusion as tumor mass or desmoids in anterior chest wall. In this case, rectus sternalis was seen associated with renovascular and other musculoskeletal anomalies. Accidental finding of rectus sternalis might be a predictor for renovascular anomaly for surgeons and radiologist.

Objective: The purpose of this study was to evaluate the accuracy of sex determination from the measurement of the area formed by 3 craniometric points related to the mastoid process i.e the porion, asterion, and mastoidale points in 3D reconstructed computed tomography of skull and comparison of its finding with the studies done by other authors where morphomertric analysis of mastoid process is done by manual method using vernier caliper or xerographic copies of skull or from CT Scan. Method: For the study, 200 3D reconstructed CT scan images of skull were analysed, 100 were males and 100 were females. The three craniometric points were marked to demarcate a triangle on both side of 3D skull and measurement was done by using Radiant Dicom software. Results: We observed that the mean of all mastoid parameters was more in male than in female. Even the surface area of mastoid process was higher in male than female. Results of present study compared with studies done by different workers in different regions. Each study showed that all the mastoid variables i.e distance from Porion to Mastoidale, Asterion to Mastoidale, Asterion to Porion and surface area of mastoid process were more in males than in females which correlates with our study. Conclusion: Knowledge of above dimensions of mastoid process and comparision of its findings with various methods of measurement increases the accuracy of sex determination.

Context: Superficial veins of upper limbs play an important role in vascular surgeries and in diagnostic and therapeutic procedures. These veins are clinically important for venipuncture, transfusion and cardiac catheterization. Aim: To study variations in the superficial veins of cadavers of human upper limbs. Settings and design: Institution based cross sectional study was carried out at Anatomy Department, JN Medical College, Belgaum. Methods: The findings observed among 25 cadavers were site of origin of the vein, course of the vein, termination of the vein, variations of the vein and length of the vein. Appropriate procedures were followed and due respect was given to all cadavers. Statistical analysis: The data analyzed using mean, standard deviations. Students t test was used to test the differences in the mean values. Results: Average length of veins in left upper limbs of female and male cadavers for cephalic was 52.7 and 50.9 cm, basilic vein 51.1 and 49.8 cm, median cubital vein 8.9 and 9.4 cm and median vein of forearm 13.9 and 17.4 cm respectively. Average length of veins in right upper limbs of female and male cadavers for cephalic was 53.9 and 52.1 cm, basilic vein 48.7 and 49.6 cm, median cubital vein 8.6 and 9.8 cm and median vein of forearm 18.2 and 17.4 cm respectively. All these differences were statistically not significant. Conclusion: Mean length veins in right and left upper limbs were similar for both males and females. Type III Dorsal venous pattern was the most commonly seen and all cases were seen only in males.

Keywords: variations, superficial veins, cadavers, human, upper limbs

Introduction: The Coronary veins are used as a conduit in various invasive cardiological procedures for arrhythmias and heart failure. The present study aims to study variations in anatomy of coronary sinus and its tributaries. Materials and Methods: The study was conducted on 110 formalin fixed cadaveric hearts. The coronary sinus was observed for its length, formation, tributaries, Thebesian valve and Vieussens valve. The transverse and craniocaudal diameter of coronary sinus ostium were measured. Results: The Coronary Sinus (CS) was classified into five types according to the formation by joining of tributaries. Type I CS was most common and observed in 52 (47.3%) specimens, which was formed by joining of great cardiac vein (GCV) and Oblique vein of left atrium (OBV). The mean length of CS was found as 26.09 ± 9.25 mm with range of 10.52 – 49.02 mm. In the first four types of CS, Type III CS presented maximum length of 29.94 ± 9.29 mm. The mean transverse and mean craniocaudal diameter of CSO were observed as 8.26 ± 3.13 mm and 10.18 ± 4.30 mm respectively. The Vieussens valve and Thebesian valve were present in 59 (53.63%) and 91 (82.72%) heart specimens. GCV and middle cardiac vein were present in all specimens with no variation in their course and drainage. Conclusion: Knowledge of variations in the CS and its tributaries are helpful in biventricular pacing and various invasive cardiac procedures.

Introduction: Aim of our present study was to observe variations of position of vermiform appendix in local population primarily in adults. Totally 50 adult cadavers were dissected during last 5 years for under graduates in the Department of Anatomy, Khaja Banda Nawaz institute of medical sciences, Kalaburagi, Karnataka. Length and breadth, extent of mesoappendix, position of appendix and arterial supply of appendix were studied. In our study most common position was retrocecal, least common was preileal and postileal position. Retrocecal position was seen in 66%, pelvic position was in 26%, subcecal in 4%, preileal 2%, postileal 2% and paracecal position was not observed in any cadaver. In males average length of appendix was 77.20 mm, breadth was 12.42 mm, where as in females length was 69.33 mm, breadth was 10.80 mm. In 34% cases mesoappendix extended up till tip and in 66% cases mesoappendix failed to reach the tip of appendix. In 70% cases single appendicular artery was observed and in 30% cases two appendicular arteries were present. Morphological and positional variations of vermiform appendix is a very important information, to be remembered before planning orduring any surgical procedures to prevent postoperative complications. Materials and Methods: The present study is of 50 adult vermiform appendix obtained from Department of Anatomy, Khaja Banda Nawaz Institute Medical Sciences, Kalaburagi, Karnataka. The vermiform appendix was observed in cadavers after routine dissection. Results: In 35 adult male specimens the length of appendix ranged from 30 mm–120 mm with an average being 77.2 mm. Breadth of the appendix at the base ranged from 7 mm–22 mm with an average being 12.42 mm. Mesoappendix in 17 adults specimens (34%) extended upto the tip and in 33 adults specimens (66%) the mesoappendix failed to reach the tip In 35 (70%), adult cadavers single appendicular artery was observed and in 15 (30%), cadavers double appendicular arteries were observed. Conclusion: High incidence of retrocecal position and incomplete mesoappendix in our population explains that - diagnosis of acute appendicitis is difficult. A clear cut picture of size, shape and position of appendix is very important to diagnose, based on only clinical presentation of a patient with appendicitis. The area of tenderness in appendicitis will depend upon the position of the appendix, length, part of the appendix with inflammation, direction of the appendix.

Keywords: Retrocecal; Preileal; Postileal; Pelvic; Mesoappendix.

Background and Objectives: Identifying a human individual through scientific means is a key component of forensic investigation. Anatomists, forensic scientists, anthropologists, physicians, podiatrists, and numerous other groups all over the world have studied human foot in different ways. In developing countries like India, people tend to walk barefooted for various reasons like spiritual thoughts, religious reasons, during socio-cultural events, climatic condition, in rural areas and due to socioeconomic reasons. This increases the importance of foot impression for forensic investigation. Human foot morphology is greatly influenced by the combined effects of heredity and living style. The present study was proposed to correlate the foot dimensions with body mass index of an individual. Methodology: This cross-sectional study was conducted amongst 1000 participants (500 male and 500 female) of ESIC Institute Gulbarga over a period of 14 months. Foot length, foot breadth along with stature and weight was measured. Results: Mean stature was 161.88. Mean weight (male) was 58.21 kg and female was 50.14 kg. No statistically significant correlation was observed between BMI and Foot length of both sides; whereas BMI and foot breadth on both sides had significant correlation. Linear regression equation was calculated. Interpretation and Conclusion: Statistically significant correlation wasn’t observed between BMI and Foot length of both sides; whereas BMI and foot breadth on both sides observed statistically significant correlation, r = 0.124 (right), r = 0.125 (left). This data would be useful for forensic investigations for the purpose of inclusion, exclusion of a suspect.

Background: Competency Based Medical Education (CBME) requires that we shift from didactic lectures to small group teaching method and provide early clinical exposure to students to make them more competent and skilled Indian Medical Graduates. Case Based Learning (CBL) is an interactive, studentcentered and instructor-led learning method that promotes learning for competence and provides opportunities for integrated teaching. Aims and Objectives: 1. To introduce CBL as a Teaching–Learning Method for teaching Neuroanatomy. 2. To obtain feedback from students and faculty about their perception and experience of CBL as a teaching learning method. Methodology: 1. Hundred (100) students were given  ve CBL sessions on neuroanatomy (ascending and descending tracts) by dividing them into  ve groups comprising of 20 students each. 2. Prior to CBL sessions the students were taught ascending and descending tracts in the same small groups in rotation by 5 faculty members. 3. After the CBL sessions in small groups the students were assessed on the basis of an MCQ test on their knowledge of ascending and descending tracts. 4. Post sessions anonymous Google Based Questionnaire was given to students and faculty to assess their perceptions of this teaching learning method. Findings: Seventy-eight (78) students responded to the feedback questionnaires out of which 95% students agreed that CBL in small groups was an effective learning tool and 95% felt that clinical case scenarios helped in meaningful progression of learning. Conclusions: CBL was perceived as an effective teaching and learning method. It was practically relevant and added the clinical aspect to the theoretical concepts. It induced the students to think and apply their knowledge to solve the clinical cases scenarios given. Active learning was achieved as students interacted in small groups as compared to didactic lectures. Small groups discussions and interaction with faculty led to better understanding of the concepts.

Keywords: Small group teaching method; Case based learning; Neuroanatomy; Interactive teaching method; CBME.

The essential segments of the skeleton are the human skull and cranium which have received significant attention in forensic research especially in the analysis of ethno-racial relationship. The features within it (example orbit) may give further insight into the understanding of the craniofacial anthropometry. Understanding the structural disposition of the human body is aided by the advances in medical imaging techniques such as radiography, MRI, CT scan etc. But direct measurement on dry skulls is a more natural perspective in assessing the orbital cavities. Conclusion: Periorbital and facial injuries are mainly caused by assaults and falls and at times may involve the forehead. Such injuries necessitate cranial and orbital reconstructions to correct both esthetic and functional deficits. Care must be taken to prevent damage to the neurovascular structures contained in the orbit or within its walls. In order to achieve this, the surgeon needs to have a proper understanding of the human orbital structure, its relationship with both intra- and extracranial structures, and associated key surgical and anatomical landmarks.

Variations are very commonly found in different vessels of the body. Gonadal vessels also show numerous variations which are important in surgeries of posterior abdominal wall. Also, these vessels are closely related to renal vessels, so, variable origins of these vessels are of utmost importance in renal surgeries. Present study was undertaken to observe the variations in the gonadal vessels. Materials and Methods: 30 cadavers (26 males and 4 females) embalmed in 10% formalin were procured from the Anatomy Department of, D Y Patil Medical College, Pune. So, sixty gonadal vessels were dissected for this study. The variable levels of origin of gonadal arteries from abdominal aorta as well as variable origins of the same were noted down. Also, the variable draining pattern of gonadal veins were noted. Photographs of all the variations were taken. Results: Numerous variations in origin, level and source of origin of testicular arteries and ovarian arteries were found. Common variation found was their origin from accessory renal arteries. Gonadal veins also showed, variable draining patterns with sometimes duplication of veins. Conclusion: Variant origin and draining pattern of gonadal vessels are important in the surgeries of posterior abdominal wall, renal surgeries like renal transplant, surgical excision of tumors of posterior abdominal wall, surgeries on abdominal aorta etc. Also, these variations are important for radiologists and also, for surgeries of varicocoele and testicular tumors.

Context: Surgical techniques have advanced rapidly over the years. Surgeons need to update themselves with these advances. Many surgeons also feel the need to hone their surgical skills so as to achieve best possible management of their patients. To facilitate this, Surgical Workshops (SWs) are organized in medical colleges. For these workshops to be effective, it is necessary that cadavers used in these workshops be embalmed in such a way that they resemble the body in natural state as far as possible. Aims: To compare the two embalming methods– formal in solution and saturated salt solution in terms of (a) Sterility of body tissue/fluids achieved; (b) Range of motion in joints postembalming; (c) Ease of performing incision on abdomen. Settings and Design: A total of 16 cadavers were taken for this study. These were all donated bodies between the age group 50–80 years. Materials and Methods: These cadavers were divided into Two Groups: Group A and Group B. Each Group had four male and four female cadavers. Group A was embalmed using formalin solution and Group B was embalmed Saturated Salt Solution (SSS). Bacterial culture tests and measurement of ranges of motion were conducted for each cadaver. In addition, incision followed by suture were performed in the cadavers. Statistical analysis used: Mann Whitney U test. Results: The SSS method had a sufficient antibiotic effect and produced cadavers with flexible joints and a high tissue quality suitable for surgical workshops. The surgeons found the cadavers embalmed by the SSS method to have a higher range of mobility than those embalmed by the formalin method. Conclusions: Cadavers embalmed by the SSS method are optimum for SWs. This method is simple, carries a low infectious risk, and is relatively of low cost, enabling a wider use of cadavers for training in surgical techniques.

Keywords: Cadaver; Embalmed; Formalin; Salt; Surgical; Workshop.

Introduction: Bifid ureter or incomplete type of double ureter is a rare congenital anomaly where separate pelvicalyceal system drain into separate ureter because of branching of ureteric bud, but they unite before draining into urinary bladder to open through single ureteric orifice. It’s more common in females and on right side. Objectives: The knowledge about the incidence of bifid ureter and its surgical and embryological significance is of immense value for urologist and renal transplant surgeon. Methods: 25 cadavers embalmed in 10% formalin formed material of this study, identification of bilateral ureter and tracing of their course till urinary bladder was done, bifid ureter were seen on right side. After removal of intestine and mesentery, posterior abdominal wall was exposed, kidneys were cleaned by removing the fascia and meticulous dissection was done to trace ureters till pelvic cavity, number of bifid ureter were noted and photographs were taken. Results: 2 cases showed presence of bifid ureter on right side where two ureters were descending down from the hilum posterior to renal vessels were seen, in one case they were uniting at a distance of 13.5 cm and in second case at a distance of 3.5 cm from the ureteric opening into urinary bladder. Course of ureter in pelvis was normal. Conclusion: Review of literature suggests that duplication of ureter is seen very infrequently. It may be an accidental radiological finding in a patient or may be detected during autopsy. Therefore surgeons and clinicians should be aware of this anomaly to prevent iatrogenic injuries during surgeries and treating renal pathologies.

Background and Aims: With the increasing advancement in the cardiac imaging techniques, it is mandatory to have a proper knowledge in the anatomy of coronary arteries. The present study is conducted to find out the normal and variations of the branching pattern of coronary arteries in human cadaveric hearts. Coronary dominance was also analyzed. Materials and Methods: 50 human hearts preserved in 10% formalin were collected from our Department of Anatomy of our institution. Observations: In this present study, 8% of specimens had third coronary artery, the posterior interventricular arteries were two in number in 22% of specimens. Left coronary artery trunk gave two branches in 80% of the specimens and three branches in 20% of specimens. Right coronary dominance was in 72% of specimens and left coronary dominance was in 28% of specimens. Myocardial bridges were present in 18% of specimens. Conclusion: Studying the variations of coronary artery is helpful for the interventional cardiologist, radiologist and cardiovascular surgeons to interpret in diagnostic and therapeutic procedures.

Context: The study of veins of the upper limbs in living humans and also the study of dorsal venous arch pattern in the upper limbs are important. Aim: To study the patterns in the dorsal venous arch and superficial veins of upper limbs in humans. Settings and Design: Present cross-sectional study was carried out at JN Medical College, Belgaum. Methods: Institution based cross sectional study was carried out among 100 study subjects of age 18–70 years in whom the superficial veins were prominently seen. Tourniquet, Pencil, Rubber, measuring tape, Thread, Camera were used. A tourniquet was tied obliquely to slightly abducted arm inferomedially at the level of lower border of teres major and superolaterally up to greater tubercle of humerus. The superficial veins of upper limb were made prominent by asking person to flex and extend elbow and wrist alternately for 2–3 times. Superficial veins of the arm, forearm and hand were studied and the parameters of the veins like Site of origin of the vein, Variations of vein, Course and length of vein up to the tourniquet were noted down. Statistical Analysis: The data was described as mean values and difference was assessed by using t - test. Results: We observed five different patterns in cubital fossa. 11 different patterns were observed in right hand and 10 in left hand. The mean length (cm) of cephalic vein, basilic vein, median cubital vein and median vein of forearm in left upper limb of females was 51.6, 50.8, 11.3, 18.1 respectively, in left upper limb of males was 53.2, 50.4, 11.6, 18.1 respectively, in right upper limbs of female was 51.3, 50.8, 12.7, 17.9 respectively, and in right upper limbs of male was 51.9, 50.4, 11.6, and 17.5 cm respectively. These differences were statistically not significant. Conclusion: Five different patterns in cubital fossa. 11 different patterns were observed in right hand and 10 in left hand.

Keywords: Patterns; Dorsal venous arch; Veins; Upper limbs; Humans.

The success of any transplant lies in the surgeons ability to preserve its vascular supply and its rapid reconstruction, especially in free vascularized bone grafts, which preserve viability of osteocytes, act as a space filler and introduce a new vascular bed for the reconstruction of defects following trauma, tumour resection, congenital pseudoarthrosis and any cases of difficult non-union bones. Aims and Objectives: The aim of the present study is to: 1. To determine the number and position of the nutrient foramina in the upper and lower limb long bones. 2. To determine the location and direction of nutrient canal. 3. To determine whether the nutrient foramina obey the general rule that is directed away from the growing end of long bone. Materials and Methods: The present study is carried out on 150 human cleaned and dried bones of the Upper limb. The samples were taken from Narayana Medical College, Chinthareddypalem, Nellore and Sri Venkata Padmavathi College (SVIMS), Tirupathi of Andhra Pradesh. The long bones included for the study was as follows: Humeri – 50, Radii – 50, Ulnae – 50. All the bones that were taken for the study were normal and had no pathological changes were present. The age and the sex of the bone were unknown. In all these bones after determining the side of bone, the “Nutrient Foramen” were studied in regards with: 1. The number of foramina on the shaft of the bone; 2. Surface on which it was located; 3. Direction from growing end; 4. Location in relation with length of the shaft. Observations and Results: Total 150 long bones of upper limb of right and left side of unknown age and sex were taken for the study. The parameters studied were depending on the number of nutrient foramina, direction of foramina and their distribution at various levels. The results and observations of the study are presented as tables. Conclusions: Importance of nutrient foramen is relevant to fracture treatment. Combined periosteal and medullary blood supply to the bone cortex helps to explain the success of nailing of long bones fractures particularly in the weight bearing like femur and tibia uses of vascularized fibula bone in bony defects due to trauma. Currently, the detailed study of blood supply to long bone is a determining factor for the success of newer techniques and resection in orthopedics.