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Background: Schwannoma and neurofibroma constitute benign peripheral nerve sheath tumors (BPNSTs), which may present as single or multiple lesions. Multiple schwannomas are rare in the peripheral nerves of the upper extremity. Solitary small schwannoma is usually asymptomatic, while larger and multiple schwannomas may have different symptoms due to pressure effects. Median and ulnar nerve communications are often encountered in the upper limb, making these anastomoses clinically important. However, such communications with schwannomas in the axilla are rare. Case Report: The study protocol was designed per the prevailing guidelines of the Institute on the use of human cadavers for teaching and research. Written informed consent was obtained from the family of the body donor at the time of whole-body donation. The upper extremities, including the brachial plexuses of both sides, were carefully dissected as per the instructions in Cunningham’s Manual of Practical Anatomy15th edition. Discussion: Unusual anastomoses in the axilla and two encapsulated, highly vascular fusiform masses were observed. Another fairly large mass was noted on the right chest wall. Histological examination confirmed the masses to be schwannomas. Conclusion: Asymptomatic schwannomas often remain undiagnosed, and those lying in the axilla can be misdiagnosed. Awareness of such variant anatomy will enable clinicians and surgeons to plan more appropriate diagnostic and therapeutic interventions. [ABSTRACT FROM AUTHOR]

Purpose: The saphenous nerve is a predominantly sensory nerve. It is the longest nerve of the body which supplies the skin of the medial side of the leg and foot as far as the ball of the great toe. We present here an unusual motor branch of the saphenous nerve to the sartorius muscle. Method: Institutional guidelines for use of human cadaver were followed. Routine dissection of the lower limbs for undergraduate medical teaching was performed in a 67 years old female cadaver employing standard methods. Relevant gross features of the variations were photographed. H&E staining of relevant structure was done and photomicrographed. Results: The unusual motor branch to Sartorius was observed in the right thigh. The branch was given off in the lower third of the thigh after the saphenous nerve exited the adductor canal. The branch was distinctly seen entering the substance of the sartorius. The structure was confirmed to be a peripheral nerve by histological examination. The saphenous nerve then descended between the sartorius and gracilis tendons, pierced the fascia lata and became cutaneous. Conclusion: The motor branch to the sartorius muscle is a very rare branch whose knowledge is important for clinicians as it can get damaged during arthroscopy and other knee surgery or during adductor canal block. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed to assess the perceived need among surgical residents to revisit their anatomical knowledge and evaluate their attitude towards integrating clinical anatomists into surgical residency program curriculum. BACKGROUND: While medical students learn human anatomy during undergraduate years, the practical application of clinically oriented anatomy becomes vital in surgical specialties. However, this aspect has not been adequately addressed in Indian surgical residency programs. METHODS: An 11-item questionnaire, including closed-ended and Likert-scale questions, was administered to 153 surgical residents. Consent was obtained, and responses were collected via Google Forms. RESULTS: Half of the respondents (50%) felt confident in their self-d irected anatomy learning, but 87% believed integrating clinical anatomists would enhance their su rgical expertise. Additionally, 88% saw value in revisiting cadaveric dissection. Third-year residents showed a significantly higher inclination towards cadaveric dissection. Deficiencies in the curriculum and time constraints were identified as major barriers. CONCLUSION: The study highlights a perceived need among surgical residents to augment their anatomical knowledge, advocating for the integration of clinical anatomists and cadaveric dissection into training. A collaborative approach, emphasizing both horizontal and vertical integration of anatomy, is recommended to enhance surgical education and practice. (Tab. 4, Fig. 1, Ref. 25). Text in PDF www.elis.sk [ABSTRACT FROM AUTHOR]

The median sacral artery (MSA) is the single unpaired dorsal branch of the abdominal aorta. The present case describes the relatively unusual origin of the median sacral artery in common with the fourth pair of lumbar arteries via a common trunk in a 74-year-old male cadaver. Unusual common trunk is prone for iatrogenic injury in surgeries of the lumbar and pelvic region. Owing to the deep seated nature of MSA close to the periosteum of lumbar vertebrae and sacrum, detection of accidental rupture of MSA and ligation thereof becomes a difficult task. MSA is also increasingly being utilized for intra-arterial embolization of pelvic tumours. The proximal portion of the common origin may at times undergo cone shaped dilatation which is referred to as infundibulum or infundibular dilatation and can also transform into aneurysm later. Knowledge of this variation is imperative for spine and pelvic surgeons to avoid unwanted complications. [ABSTRACT FROM AUTHOR]

Copyright of Medeniyet Medical Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: cholecystohepatic duct (CHD) is one of the important but rare anatomical variations of extra hepatic biliary apparatus. It can get injured easily if proper care is not taken intraoperatively leading to prolonged bile leakage and postoperative complications. Two cases of this rare variation were found intraoperatively during cholecystectomy. CHD was arising from right hepatic duct and communicating with body of the gall bladder in both cases. These were type E6 accessory bile duct according to Goor's classification. In the present case, intraoperative identification of anomaly could avoid subsequent post operative complications due to prolonged bile leakage. Hepatobiliary surgeons performing surgery in the region of calot's or cholecystohepatic triangle should always keep in mind probable presence of CHD. A high index of clinical suspicion and vigilance can prevent subsequent grave complications. [ABSTRACT FROM AUTHOR]

Introduction: variable insertions of peroneus tertius (PT) muscle tendon is described by various authors. Mention of extra PT tendon is also described in literature. Autologus tendon grafting is a blooming arena of clinical research at present time. Scarcity of auto graft and difficulty of choosing an appropriate auto graft often perplex reconstructive surgeons. There is paucity of data with regard to use of PT muscle tendon as auto graft. Case Report: we report here an extra tendon of PT muscle joining with the extensor digitorum longus (EDL) tendon. The extra PT tendon with optimum length and thickness is indeed an additional advantage from the point of view of auto graft harvesting. Discussion: we believe that though partial or total removal of the PT tendon might result in some degree of functional loss in maintaining steadiness and eversion, but presence of extra tendon will enable to use only the extra tendon not directly involved in primary action thereby minimising any possible functional impairment. An extra tendon of the PT muscle comparable in dimension with that of its primary tendon as reported here has promising opportunities in tendon grafting. Conclusion: the anatomical variation of extra tendon of PT can be of tremendous future prospects to be used as an alternate tendon auto graft in ligament repair. [ABSTRACT FROM AUTHOR]

Introduction: anatomical variation of inferior gluteal nerve (IGN) has not received much attention from clinicians. Mechanical injuries of IGN such as entrapment, compression by adjacent structures in the gluteal region are not infrequent. The present case reports unusual bilateral IGN anatomical variation formed by variable contributions of dorsal division of ventral rami (L5, S1 & S2) entering below the piriformis. On the right side, the upper root of IGN traversed the space alone and supplied the medial part of the gluteus maximus (GM). The middle and lower roots accompanied the inferior gluteal artery (IGA), encircled it and formed the lower root of IGN dorsal to the artery; which then supplied the lower part of GM. On the left side, the upper and the middle roots encircled the IGA and then united to form the upper root of the IGN. The middle root arose in common with the posterior cutaneous nerve of the thigh. The lower root traversed the space alone superficial to the sciatic nerve and supplied the left GM. The roots of IGN embracing the IGA (the lower two roots on the right side and the upper two roots on the left side) from before backwards place it in a vulnerable position for compression in the event of any vascular lesion like arterial aneurysm. IGN neuropathy can present as abnormal gait or kinesiological disturbance. Awareness of such variation will aid in clinical diagnosis. [ABSTRACT FROM AUTHOR]

Copyright of Medeniyet Medical Journal is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This document is a letter to the editor of the Medeniyet Medical Journal, titled "Clarifications Regarding 'Investigation of Morphological and Biomechanical Properties of the Scapula for Shoulder Joint'." The authors of the letter express their interest in the article and commend the authors for their efforts. However, they raise several points of clarification and concern, including negative values in calculations, missing references, and incomplete information about the sample size and scapulae used. They also request clarification on the use of the term "biomechanics" in relation to a study conducted on dry bone. The authors conclude by expressing their appreciation for the editor's consideration and requesting a response from the original authors. [Extracted from the article]

Introduction: supracondylar foramen of humerus is a rare finding while supracondylar spur has been found with variable incidences in different population groups. Presence of complete foramen can be attributed to ossification of struther's ligament. Reporting about this type of variation is sparse in literature. It may cause supracondylar syndrome by compression of median nerve, ulnar nerve and brachial artery leading to neurovascular compromise in forearm and hand. Case Report: during routine bone demonstration of humerus to undergraduate MBBS students, supracondylar foramen was found in one specimen. Completely ossified bony bridge extending from medial epicondyle to anteromedial surface of humerus was found. Conclusion: generally, this type of variation is asymptomatic. Sometimes, it can be symptomatic if median nerve, ulnar nerve or brachial artery is/are compressed within this foramen. It is important to include this variation in differential diagnosis in patients with neurovascular symptoms around elbow, forearm and hand. Also, it can mimic as benign and malignant tumors involving lower end of humerus. The mainstay of management is removal of ossified bony bridge by either open or arthroscopic surgical approach. [ABSTRACT FROM AUTHOR]

Objectives: To report an outbreak of invasive meningococcal disease from Meghalaya, in the north east India, from January 2008 through June 2009. Methods: Retrospective review of case sheets was done. One hundred ten patients with invasive meningococcal disease were included for the study. Results: Of the total patients, 61.8 % were boys and 38.2 % were girls (boy to girl ratio = 1.62:1). The average age of presentation was 8.48 ± 5.09 y. Meningococcal meningitis was seen in 61.8 % of cases, meningococcemia in 20 % and 18.2 % had both. Fever was the most common manifestation (100 %) followed by meningeal signs (78.2 %), headache (56.4 %), vomiting (53.6 %), shock (38.2 %), low Glasgow coma scale (GCS) (25.5 %), purpura and rashes (23.6 %), seizures (9.1 %), abdominal symptoms (4.5 %), irritability and excessive crying (4.5 %) and bulging anterior fontanalle (23 %) in those below 18 mo of age. Raised intracranial pressure (ICP) was the most common complication (28.2 %) followed by coagulopathy (16.4 %), hepatopathy (10 %), herpes labialis (9.1 %), syndrome of inappropriate ADH secretion (SIADH) (8 %), pneumonia (7 %), arthritis (6 %), purpura fulminans, respiratory failure, sixth nerve palsy and diabetes insipidus in 4.5 % each, subdural empyema, optic neuritis, ARDS and ARF in 1.8 % each, cerebral salt wasting syndrome, third nerve palsy, cerebritis and hearing impairment in 0.9 % each. Culture was positive in 35.5 %. Patients were treated initially with ceftriaxone and dexamethasone but later on with chloramphenicol due to clinical drug resistance. Mortality was 6.4 %. Conclusions: This is the first epidemic report of invasive meningococcal disease from the north east India. Chloramphenicol acts well in areas with penicillin or cephalosporin resistance. Mortality reduces significantly with early diagnosis and prompt intervention. [ABSTRACT FROM AUTHOR]