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The branches of the external carotid artery can show variation, and common trunks are occasionally found. Because the common trunks such as the thyrolingual, linguofacial, and thyrolinguofacial trunks are formed from two or all of the superior thyroid artery, lingual artery, and facial arteries, maxillofacial trunks are extremely rare. We report a rare case with the maxillofacial and thyrolingual trunks identified by three-dimensional computed tomography angiography. [ABSTRACT FROM AUTHOR]

Hemifacial spasm (HFS) results from vascular compression at the root exit of the facial nerve. Although the underlying etiology has yet to be identified, it has been suggested that congenital vascular anomalies are involved. We have hypothesized common trunk anomaly of the anterior inferior cerebellar artery (AICA) and posterior inferior cerebellar artery (PICA) which may play a role in HFS. However, no previous studies have directly compared the incidence of this anomaly between HFS patients and normal subjects. The present study was designed to address this gap in the literature. This case-control study compared magnetic resonance angiography data from 65 HFS patients and 65 normal subjects. Dominant AICA/PICA is defined as the absence of PICA/AICA, with the remaining AICA/PICA supplying both vascular territories. The term "common trunk" encompasses both dominant AICA and dominant PICA. The frequency of common trunk and dominant AICA/PICA was compared between the 2 groups. There were no significant differences in the incidence of a common trunk (68.5% and 64.6%), dominant AICA (30.8% and 32.3%) and dominant PICA (37.7% and 32.3%) between the 2 groups. Additionally, no differences were found in the frequency of atherosclerosis risk factors. There was no apparent association between common trunk anomaly and HFS. It is suspected that some vascular anomalies other than a common trunk are involved in HFS. [ABSTRACT FROM AUTHOR]

Introduction: The rich vascularity of most parts of the head and neck is mainly maintained by the carotids and their branches. However, variations in the External Carotid Artery (ECA) and Superior Thyroid Artery (STA) can pose risks during neck surgeries. Aim: This study aimed to examine relationship of ECA at point of origin and variations in the origin of superior thyroid artery. Materials and Methods: A cross-sectional study was conducted at the Department of Anatomy, Government Medical College, Kota, Rajasthan, India. Fifty common carotid arteries were obtained from 20 adult human cadavers and five sagittal sections of head and neck specimens. The specimens were dissected bilaterally, resulting in a total of 50 carotids observed. Data analysis was performed using SPSS software version 25. Results: In 86% of the specimens, the ECA originated at the upper border of the thyroid cartilage, while in 14% of the specimens, it was at a higher level. Transposition of the ECA laterally was observed in 4% of the specimens, and medial transposition was observed in 96% of the specimens. The STA originated from the ECA in 76% of the specimens, from the carotid bifurcation in 16% of the specimens, and from the Common Carotid Artery (CCA) in 8% of the specimens. Conclusion: The anatomical level of the CCA bifurcation is crucial clinically and surgically. These findings contribute to our understanding of the vascular anatomy of the carotid triangle, aiding students, radiologists, and surgeons in preventing complications and improving head and neck surgeries.

Background: The common trunk anomaly of the anterior and posterior inferior cerebellar artery (APC) is a variant artery that causes a hemifacial spasm (HFS). The anatomical characteristics include a large diameter of the trunk and the existence of the bifurcation near the facial nerve root entry zone (REZ). Despite APC being encountered at a constant rate in microvascular decompression (MVD), the anatomical and technical issues of transposing APC have not been entirely focused on yet. Methods: We reviewed our 68 cases with APC involvement. Patient background, radiological findings, and operative video recordings were reviewed retrospectively. The location of the bifurcation of APC and the distribution of perforators were investigated. Surgical outcomes were assessed in the long term. Results: APC involvement was diagnosed preoperatively in all cases by careful observation with MRI. Three-dimensional images determined the anatomical characteristics of APC and depicted the relationship with the facial nerve. All patients had a bifurcation close to the root entry zone that was required to transpose, including the common trunk and the distal branches, to achieve sufficient decompression. While adequate transposition from the REZ was accomplished in most cases, it was difficult to complete transposition due to short perforators in 6 patients (8.8%), resulting in interposition. Fifty-three patients (77.9%) became spasm free immediately after surgery, 66 patients (97.1%) were after 6 months, and all patients (100%) became spasm free within a year. Spasm-free status was maintained during the follow-up period (4.7 years) in all patients except one in whom facial spasm recurred 2 years after the initial surgery. Conclusions: Transposing the common trunk with the bifurcation and distal branches contributes to obtaining favorable surgical outcomes in APC-related HFS. [ABSTRACT FROM AUTHOR]

Purpose: In this article, we describe a complex and rare variant of the common trunk arising as a branch of the subclavian artery. This description highlights the clinical relevance of such a variation for medical practice. Methods: A routine dissection was carried out on an adult 74-year-old female cadaver. After identification and preparation of the common trunk, measurements and photographs were taken. Results: The dissection revealed a common trunk arising from the first part of the left subclavian artery. It divided into the left internal thoracic artery, the inferior thyroid artery, and the thyrocervical trunk. Further on, the branches of the thyrocervical trunk supplied blood to the trapezius muscle, the longus colli muscle and the supraspinatus muscle. Conclusion: For the first time, we report the specific appearance of a common trunk from the left subclavian artery that includes the origin of the left internal thoracic artery, inferior thyroid artery, and thyrocervical trunk. Knowledge of the different variations of subclavian branches is essential because of the high frequency with which this region is involved in diagnostic and surgical procedures. Level of evidence: II Basic Science Research. [ABSTRACT FROM AUTHOR]

In clinical and surgical procedures, the variable origins of the axillary artery branches are significant for identifying uncommon signs and symptoms. The present case report documents an unusual origin of the axillary artery branches during dissection of a male cadaver in the Anatomy Department of an undergraduate and postgraduate teaching medical college in India. Normally, the superior thoracic artery arises from the first part of the axillary artery. In the present case, the second part of the axillary artery gave rise to a common trunk, from which the thoracoacromial, lateral thoracic, and subscapular arteries originated. Further, the thoracodorsal, circumflex humeral, and posterior circumflex humeral arteries originate from the subscapular artery whereas the anterior circumflex humeral artery only originates from the third part of the axillary artery. During surgical procedures performed in the region of the axilla, anatomists, radiologists, and cardiologists need to be aware of variations in the origin of axillary artery branches.

Superselective intra-arterial chemotherapy (SSIAC) for oral cancer can deliver a higher concentration of anticancer agent into a tumor-feeding artery than intravenous systemic chemotherapy. However, the agent distribution between the lingual artery and facial artery (FA) is not clear in SSIAC for patients with the linguofacial trunk. The agent distribution in the SSIAC method was investigated using computational fluid dynamics (CFD). Ten three-dimensional vessel models were created from CT images of two patients with oral cancer (patients A and B) with the linguofacial trunk. Catheter models were combined with vessel models to mimic intra-arterial infusion, and the agent flow was analyzed. In patient A models, the agent distribution varied depending on the catheter tip position in the linguofacial trunk, while all anticancer agents flowed into the FA only in patient B models. This study revealed that the behavior of the agent in the common trunk is determined by the blood flow field which depends on the topography of the vessels in each patient. Therefore, the catheter tip position should be changed according to the vessel topography to deliver anticancer agents into the tumor-feeding artery. Moreover, CFD can be a useful method to predict the agent flow for each patient before SSIAC. [ABSTRACT FROM AUTHOR]

Summary: Background: In 2015 medical training regulations have been restructured for postgraduate medical training in Austria resulting in a significant shortening of the training period. Furthermore, a restriction of working hours for physicians to 48 h per week was implemented affecting the framework of postgraduate medical training. The aim of this study was to obtain a self-assessment of students and young physicians in Austria regarding their self-confidence in clinical skills and their working and learning environment. Methods: In this study 6th year medical students, physicians in their basic training (common trunk), physicians in family medicine training, and residents in their first 18 months of training were asked to participate in a survey. Self-reported data were collected for five different prespecified domains (communication, motor skills, knowledge, documentation, and emergency). Results: In all domains, self-confidence increased significantly during medical training. Analysis further revealed better results of residents compared with all other groups in all domains, whereas physicians in family medicine training only rated themselves better in the documentation domain (p = 0.010); however, the interest in family medicine was low, even among physicians in family medicine training. The workload significantly increased during medical education, with the highest stress levels for physicians in family medicine training and residents (p = 0.001). Conclusions: Self-confidence of young physicians but also their stress levels increased during the medical training. Further studies are needed to answer the question why the interest in family medicine was so unexpectedly low in this cohort. [ABSTRACT FROM AUTHOR]

Background. Atrial fibrillation (AF) is a common clinical problem. The left atrium anatomy makes up a factor that may significantly affect the effectiveness of the AF ablation. Objectives. The aim of the study was to evaluate a long-term effectiveness ablation in patients with common pulmonary vein trunk (CPVT) and AF. Material and methods. The outcomes of 129 procedures in 95 patients with CPVT out of 1,475 procedures carried out in 1,150 patients with AF treated with ablation, were analyzed. Ablation with CARTO 3 system (Johnson & Johnson, New Brunswick, USA), cryoballoon, and the circular multipolar duty-cycled radiofrequency-based pulmonary vein ablation producer with catheter (PVAC) were considered as advanced methods. The following data was recorded for every patient: age, gender, AF duration and type, previous antiarrhythmic drugs, weight, height, any prior cardioversion, and comorbidities, including hypertension, diabetes, hypothyreosis, thyrotoxicosis, heart failure, and stroke/transient ischemic attack. The following anatomical factors were assessed: the presence of patent foramen ovale (PFO) and localization of the CPVT on the basis of venography or computed tomography (CT). In the 1st year after ablation, 24-hour Holter monitoring was performed 3-5 times, and the patients were encouraged to visit their doctor or an emergency department if a cardiac arrhythmia occurred. Long-term ablation effectiveness was assessed based on a telephone interview and patients' answers to the questionnaires including 12-lead electrocardiography (ECG). Results. Sinus rhythm was maintained in 44 patients (43.6%) after a median of 42 months (range: 12-120). A lower number of clinical factors (odds ratio (OR) = 0.09; 95% confidence interval (95% CI) = 0.02-0.56; p < 0.01), and advanced ablation methods (OR = 3.1; 95% CI = 1.4-7.1; p < 0.01) were related to a better long-term effectiveness. Conclusions. The long-term effectiveness of pulmonary vein (PV) isolation in patients with AF and CPVT is higher when advanced ablation techniques are used. Accumulation of clinical factors was found to be the most tremendous predictor of AF recurrence. [ABSTRACT FROM AUTHOR]

Background and aims: Study of origin of obturator artery, its variable origin and course is significant as knowledge attained by such studies help surgeons to avoid injuries, hemorrhage during operative procedures. Present study is aimed at finding out the variable origin of obturator artery, clinical significance and to correlate its embryological basis. Materials and Methods: Present study was conducted on 60 formalin fixed hemi section of cadaveric pelvis, which were allotted to the under graduate students of Mandya Institute of Mcdical Sciences, Mandya. Observations obtained were compared with the studies of previous workers. Results: Normal pattern of origin, from the anterior division of internal iliac artery was seen in 40% (24 cadavers). In 60% of the cadavers variations were observed. The most common variant mode of origin was from inferior epigastric artery (18.3%). Next common was origin from superior gluteal artery and least common variant of origin was from inferior vesical artery. Conclusion: Variations observed in present study were at par with the variations observed by previous studies. Although anomalous origins of the obturator artery rarely produces clinical symptoms, their knowledge is necessary for operating surgeons to avoid injuries and is of academic interest.

Superselective intra-arterial chemotherapy (SSIAC) for oral cancer can deliver a higher concentration of anticancer agent into a tumor-feeding artery than intravenous systemic chemotherapy. However, the agent distribution between the lingual artery and facial artery (FA) is not clear in SSIAC for patients with the linguofacial trunk. The agent distribution in the SSIAC method was investigated using computational fluid dynamics (CFD). Ten three-dimensional vessel models were created from CT images of two patients with oral cancer (patients A and B) with the linguofacial trunk. Catheter models were combined with vessel models to mimic intra-arterial infusion, and the agent flow was analyzed. In patient A models, the agent distribution varied depending on the catheter tip position in the linguofacial trunk, while all anticancer agents flowed into the FA only in patient B models. This study revealed that the behavior of the agent in the common trunk is determined by the blood flow field which depends on the topography of the vessels in each patient. Therefore, the catheter tip position should be changed according to the vessel topography to deliver anticancer agents into the tumor-feeding artery. Moreover, CFD can be a useful method to predict the agent flow for each patient before SSIAC.

Introduction: The Left Hepatic Vein (LHV) and the Middle Hepatic Vein (MHV) presents with wide variations, the knowledge of which is very important during various surgeries of the left lobe as well as right lobe of liver. Aim: To study about the variations in the branching pattern of LHV and the MHV draining the left lobe of liver. Materials and Methods: A total of 60 adult human livers were dissected manually. The LHV and the MHV were typed into five types. Further, few of these types were again divided into subtypes. Results: The incidence of presence of common trunk of LHV and MHV was 76.6% (n=46). In 20% (n=12) livers these veins were present as separate trunks. In 3.33% (n=2), no trunk of the LHV was seen and the left medial vein and the left lateral vein were found to drain independently into the Inferior Vena Cava (IVC). Conclusion: Appropriate knowledge of the anatomy of liver is very important, for different surgical procedures for treatment of malignancies or other ailments of liver.

Coronary artery anomalies are found in around 1-2% of patients undergoing coronary angiography. Uncovering of more coronary anomalies has increased with increase in awareness and easy availability of non invasive Computed Tomography Coronary Angiography (CTCA). We present a rare case of a 64-year-old female with a history of atypical chest pain and mild ST depression ECG changes who underwent CTCA. The present case revealed unusual findings of an anomalous origin of the Left Circumflex Coronary artery (LCx) from the proximal Right Coronary Artery (RCA) with duplicated right coronary artery after arising as a common trunk from right coronary cusp. In the present case report we attempted to highlight the rarity of this coronary anomaly.

Background and aim : Study of variation in branching pattern of arch of aorta is important for cardiovascular surgeons to avoid injury during procedures like angiography and stenting of aorta. These variations are frequently encountered during surgical procedures, as a developmental alteration in branchial arch during embryonic period. The aim of present study is to describe variation in branching pattern of arch of aorta belonging to Gujarati population and these results will be of significance for anatomists for relating it with embryological basis, cardiovascular surgeons and radiologists. Materials and methods : Forty embalmed cadavers were observed for study of branching pattern of arch of aorta during period of four year in Department of Anatomy in Smt N.H.L.Municipal Medical College, Ahmedabad. Results : In the present study, normal branching pattern of the arch of aorta was found in 92.5% cases. In 2.5% cases only two vessels originated from the arch of aorta, one of them was common trunk for brachiocephalic trunk and left common carotid artery and the second trunk was left subclavian artery. In 5% of cases four vessels arose from arch of aorta , the left vertebral artery arose directly from aorta with normal branching pattern. Conclusion : Vascular invasive procedures are increasing since last decade. So knowledge of variation in branches of arch of aorta is essential for cardiologist, cardiovascular surgeon as well as for radiologist.

Introduction: The Left Hepatic Vein (LHV) and the Middle Hepatic Vein (MHV) presents with wide variations, the knowledge of which is very important during various surgeries of the left lobe as well as right lobe of liver. Aim: To study about the variations in the branching pattern of LHV and the MHV draining the left lobe of liver. Materials and Methods: A total of 60 adult human livers were dissected manually. The LHV and the MHV were typed into five types. Further, few of these types were again divided into subtypes. Results: The incidence of presence of common trunk of LHV and MHV was 76.6% (n=46). In 20% (n=12) livers these veins were present as separate trunks. In 3.33% (n=2), no trunk of the LHV was seen and the left medial vein and the left lateral vein were found to drain independently into the Inferior Vena Cava (IVC). Conclusion: Appropriate knowledge of the anatomy of liver is very important, for different surgical procedures for treatment of malignancies or other ailments of liver. [ABSTRACT FROM AUTHOR]

Knowledge of the morphological variations within the abdominal cavity is significant for all medical practitioners planning surgery. This report presents the rare origin of a common trunk for the right inferior phrenic artery, and superior and inferior suprarenal artery from the right renal artery. An accessory hepatic artery was found, which served as a branch of the right inferior phrenic artery. The diameter of the common trunk was 3.95 mm, and the diameters of the inferior and superior suprarenal arteries were 1.84 and 1.36 mm, respectively. The diameter of the right inferior phrenic artery was 2.55 mm. Both the embryological background and the potential clinical significance of this morphological variation are discussed. Knowledge of this common trunk and the occurrence of the accessory right hepatic artery may be of significance in diagnostic and surgical procedures. [ABSTRACT FROM AUTHOR]

Background and aims: Study of branching pattern of arch of aorta and its variation is very significant. This study helps in avoiding the surgical, accidental injuries of blood vessels during cardiovascular surgeries and radiological procedures. Present study is aimed at finding out the branching pattern of arch of aorta, variations of its incidence, clinical significance and to correlate its embryological basis. Materials and methods: Present study was conducted on 30 formalin fixed cadavers, which were allotted to the undergraduate students of Bangalore Medical College and Research Institute. A comparative analysis was done with previous studies. Results: Usual three-branched aortic arch was found in 23 cadavers (76.66%); variations were found in seven cadavers (23.33%); 10% presented left vertebral artery arising directly from the arch of aorta; 6.66% presented common trunk of left vertebral artery and left subclavian artery; 3.33% presented thyroidea ima artery arising from the arch; 3.33% presented common trunk of brachiocephalic trunk and left common carotid artery. Conclusion: Variations observed in present study were in par with the variations observed by previous studies. Although anomalous origins of the aortic arch branches very rarely produces clinical symptoms but their knowledge is necessary for operating surgeons and interventional radiologist to avoid complications in the thorax, head and neck region.

In clinical and surgical procedures, the variable origins of the axillary artery branches are significant for identifying uncommon symptoms and signs. The present case report documents an unusual origin of the axillary artery branches during dissection of a male cadaver in the anatomy department of an undergraduate and postgraduate teaching medical college in India. Normally, the superior thoracic artery arises from the first part of the axillary artery. In the present case, the second part of the axillary artery gave rise to a common trunk, from which the thoracoacromial, lateral thoracic, and subscapular arteries originated. Further, the thoracodorsal, circumflex humeral, and posterior circumflex humeral arteries originate from the subscapular artery whereas the anterior circumflex humeral artery only originates from the third part of the axillary artery. During surgical procedures performed in the region of the axilla, anatomists, radiologists, and cardiologists need to be aware of variations in the origin of axillary artery branches. During surgical procedures performed in the region of the axilla, anatomists, radiologists, and cardiologists need to be aware of variations in the origin of axillary artery branches. [ABSTRACT FROM AUTHOR]

We report a case of undivided retromandibular vein (RV) that was associated with the absence of external jugular vein (EJV). This variation in the jugular venous system was observed on the right side of the neck of a male cadaver. The posterior auricular vein drained into the RV, which joined the facial vein resulting in a common trunk. This common trunk then drained directly into the internal jugular vein (IJV) thus bypassing the whole venous drainage area of the EJV. It is believed that the knowledge about the venous variations, as in the present case, is enlightening to the clinicians. The preoperative evaluation of the venous system is essential to prevent complications like catastrophic bleeding and embolism. The knowledge may guide the emergency physician for a quicker cannulation of the veins. [ABSTRACT FROM AUTHOR]

During routine dissection of an adult male cadaver, a unique case of anomalous origin of linguofacial trunk from both the right and left external carotid arteries with no looping of lingual artery in its course and relative higher division of right common carotid artery at C3 vertebral level was observed. Although variations in the external carotid artery origin and branches are not uncommon it is necessary to document as these variations may increase the risk of accidental vascular trauma during head and neck surgeries. And this knowledge is also important for radiologists in the image interpretation of carotid arterial system.

Background: Variations in the origin of lower subscapular nerve of the posterior cord of brachial plexus are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of origin show population differences. Data from the South Indian population is scarce. Objective: To describe the variations in the origin of the lower subscapular nerve of the posterior cord of brachial plexus in the South Indian population. Materials and Methods: Forty brachial plexuses from 20 formalin fixed cadavers were explored by gross dissection. Origin and order of branching of lower subscapular nerve was recorded. Representative photographs were then taken using a digital camera (Sony Cyber shot R, W200, 7.2 Megapixels). Results: Lower subscapular nerves had origin from axillary nerve in 57.5% of specimens, in 37.5% specimens, it was originating from the posterior cord and in 5% of specimens it arose from common trunk. Conclusion: Lower subscapular nerves in studied population display a wide range of variations. Anesthesiologists administering local anesthetic blocks, clinicians interpreting effects of nerve injuries of the upper limb and surgeons operating in the axilla should be aware of these patterns to avoid in advertent injury.

BACKGROUND: Axillary artery is known to show different variations mostly in its branching pattern. Similarly, the origin of profunda brachii is often encountered with abnormality. Therefore, when the vascular variations in the upper limb persist, mostly it is confined to its branching pattern followed by its variant origin. But, among all the reported variations of profunda brachii, its variant origin from the 3rd part of the axillary artery with common trunk for the branches of axillary artery is unique. CASE DETAILS: We report here an anomalous origin of profunda brachii as continuation of an arterial trunk arising from 3rd part of the axillary artery. This common trunk at its commencement passed between 2 roots of median nerve and gave branches of 3rd part of axillary artery before it continued as profunda brachii artery. The further course and branching pattern of profunda brachii were normal. CONCLUSION: Since the axillary artery is next choice of artery for arterial canulation in cardiopulmonary bypass procedures, prior knowledge of existence of such variation in its branching pattern helps in avoiding possible diagnostic or interventional therapeutic errors. [ABSTRACT FROM AUTHOR]

Axillary artery, the continuation of the Subclavian artery, initiates at the lateral border of the first rib and normally ends at the lower border of teres major, where it obtains the name of brachial artery. Variations in the branching pattern of the axillary artery are common. During a routine dissection of a 25- 30-year-old man cadaver, based on the classic Grant's method, in the Department of Anatomy at Zanjan University of Medical Sciences, we observed an unusual branching in the second part of the left axillary artery. In spite of the existence of thoracoacromial trunk, the second part of the axillary artery had a common trunk for lateral thoracic and thoracodorsal arteries. The thoracodorsal artery accompanying the thoracodorsal vein and nerve entered lattissimus dorsi muscle. The axillary artery has the highest rate of rupture and damage after the popliteal artery, and it can get damaged in an attempt to either reduce old shoulder dislocations or remove axillary lymph nodes. Therefore, a full awareness of the axillary artery variations could prove very useful and essential for medical specialists, especially vascular surgeons, orthopedic surgeons, radiologists, and anatomists. [ABSTRACT FROM AUTHOR]

Background: The day to day advances in the fields of cardiac and vascular surgeries need to revive interest in the developmental and the adult anatomies of the Aortic Arch (AA) and its great vessels. A variant aortic arch branching pattern may occur with different embryological mechanisms. The variations in the branching pattern of the aortic arch may range from differences in the distance between the origins of the different branches to the number of branches. The present study was undertaken to study the variations in the branching pattern of the arch of the aorta and their surgical applications. Aim: In the present study, the anatomical characteristics of the aortic arch and its branches were evaluated by doing a macroscopic examination which has diagnostic and surgical importance. Methods: This study was conducted on 35 cadavers from the Anatomy Department, 100 aortic angiographic studies were done at the Care Hospital, Visakhapatnam and 300 CT angiographic studies were done at Vijaya Medical Centre, Visakhapatnam. This study was carried out by the conventional dissection method and by doing angiograms. Results: The normal branching pattern was observed in 26 specimens out of the 35 cadavers. The common trunk for both the brachiocephalic and the left common carotid arteries was present in 5 specimens. The left vertebral artery arose from the aortic arch between the left common carotid and the left subclavian artery in 4 specimens. Among these 4 cases, in 1 cadaver, the cervical segment of the left vertebral artery was very long and it entered through the foramen transversarium of the 3rd cervical vertebra. Whereas, in 1 cadaver, there were three branches which arose from the aortic arch, (1) the common trunk of the brachiocephalic and the left common carotid arteries (2) the left vertebral artery and (3) the left subclavian artery. Conclusions: Knowledge on the variations in the classical branches of the aortic arch is important in the diagnosis of intracranial aneurysms which occur after a subarachnoid haemorrhage. Clinicians and surgeons should be aware of the aortic arch variations. Prior identification of these vascular anomalies through diagnostic interventions is crucial, in order to avoid complications during heart and vascular surgeries. [ABSTRACT FROM AUTHOR]

Abstract: The inferior phrenic arteries constitute a pair of important vessels, supplying multiple organs including the diaphragm, adrenal glands, esophagus, stomach, liver, inferior vena cava, and retroperitoneum. The vast majority (80–90%) of inferior phrenic arteries originate as separate vessels with near equal frequency from either the abdominal aorta or the celiac trunk. Infrequently, the right and left inferior phrenic arteries can arise in the form of a common trunk from the aorta or from the celiac trunk. We herein present three patients with a new anatomic vascular variant: a common trunk of the inferior phrenic arteries arising from the right renal artery. In one case, the left inferior phrenic branch of the common trunk provided collaterals connecting with a supra-diaphragmatic branch of the left internal mammary artery and in another with the lateral wall of the pericardium. Angiographic identification of a common trunk for the inferior phrenic arteries arising from the right renal artery is important for proper diagnosis and clinical management. The presence of this unique vascular variant can impact revascularization of the renal arteries. [Copyright &y& Elsevier]

While dissecting the body of a 59 years old male cadaver we observed "abnormal" branching pattern of the axillary artery and unusual vascular pedicles of the serratus anterior muscle. The serratus anterior branch originated directly first part of the axillary artery as the first branch. The lateral thoracic and thoracodorsal arteries arose together from the third part of the axillary artery as "a lateral thoracic-thoracodorsal"common trunk. The superior thoracic artery was out of the position. The circumflex scapular artery originated directly the third part of the axillary artery. The subscapular artery was not present. [ABSTRACT FROM AUTHOR]

Background: The common trunk of the fronto-orbital artery (FOA) and frontopolar artery (FPA) arising from the A1 segment of the anterior cerebral artery (ACA) associated with a ruptured aneurysm (AN), is rare. Case Description: The patient was a 52-year-old man who suffered from subarachnoid hemorrhage. Threedimensional computed tomography angiography revealed an elongated and tortuous left A1 segment of the ACA and a saccular AN arising from the left A1 segment of the ACA at the origin of the cortical branch, defining its location just on the midline and behind the anterior communicating artery. This vessel had two branches. One branch ran along the inferior surface of the ipsilateral frontal lobe, and the other branch ran anteriorly and medially along the surface of the left hemisphere toward the frontal pole. The anomalous artery was interpreted as a common trunk of the FOA and FPA. Bifrontal craniotomy was performed. The anomalous artery arose from the A1 segment of the ACA at the origin of the AN, and the recurrent artery of Heubner branched off the anomalous artery. The AN was successfully obliterated, clipping with a bayonetshaped Yasargil titanium clip. Complete AN occlusion and patency of both the A1 and the common trunk of the FOA and FPA, were confirmed intraoperatively by indocyanine green angiography. Conclusions: Recognizing this variant preoperatively, could be helpful in preventing the complications of surgery. [ABSTRACT FROM AUTHOR]

Background: Variations in the origin of lower subscapular nerve of the posterior cord of brachial plexus are important during surgical approaches to the axilla and upper arm, administration of anesthetic blocks, interpreting effects of nervous compressions and in repair of plexus injuries. The patterns of origin show population differences. Data from the South Indian population is scarce. Objective: To describe the variations in the origin of the lower subscapular nerve of the posterior cord of brachial plexus in the South Indian population. Materials and Methods: Forty brachial plexuses from 20 formalin fixed cadavers were explored by gross dissection. Origin and order of branching of lower subscapular nerve was recorded. Representative photographs were then taken using a digital camera (Sony Cyber shot R, W200, 7.2 Megapixels). Results: Lower subscapular nerves had origin from axillary nerve in 57.5% of specimens, in 37.5% specimens, it was originating from the posterior cord and in 5% of specimens it arose from common trunk. Conclusion: Lower subscapular nerves in studied population display a wide range of variations. Anesthesiologists administering local anesthetic blocks, clinicians interpreting effects of nerve injuries of the upper limb and surgeons operating in the axilla should be aware of these patterns to avoid in advertent injury. [ABSTRACT FROM AUTHOR]

Coronary artery anomalies are found in around 1-2% of patients undergoing coronary angiography. Uncovering of more coronary anomalies has increased with increase in awareness and easy availability of non invasive Computed Tomography Coronary Angiography (CTCA). We present a rare case of a 64-year-old female with a history of atypical chest pain and mild ST depression ECG changes who underwent CTCA. The present case revealed unusual findings of an anomalous origin of the Left Circumflex Coronary artery (LCx) from the proximal Right Coronary Artery (RCA) with duplicated right coronary artery after arising as a common trunk from right coronary cusp. In the present case report we attempted to highlight the rarity of this coronary anomaly. [ABSTRACT FROM AUTHOR]