The yolk sac is the first extra embryonic structure that becomes sonographically visible within the gestational sac and acts as the primary route of exchange between the human embryo and the mother before the placental circulation is established. The yolk sac is a round structure that is made up of an anechoic center bordered by a regular well-defined echogenic rim. It is usually 2-5 mm in diameter. The yolk sac appears at 6 weeks, thereafter increases in size, attains its maximum diameter at 10 weeks and then it starts decreasing in size. It disappears at 12 weeks. Aims and Objectives of the present study is to measure the size of yolk sac in pregnancies of duration 6-12 weeks by Transvaginal sonography and also to measure the inner diameter of yolk sac and correlate it with pregnancy outcome. Materials and Methods: We studied 72 pregnant women of duration 6-12 weeks referred by Department of Obstetrics and Gynaecology. The inner diameter of yolk sac was measured by Transvaginal sonography and its correlation with pregnancy outcome was studied. Observations and Results: The mean yolk sac diameter was noted as 3.7±1.8 mm. The diameter of the smallest yolk sac was 1.25 mm and that of the largest was 8.96 mm. Yolk sac size was normal in 62 (88.57%) cases, it was smaller in size in one (1.4%) case. Further in another 7 (10%) cases, the yolk sac was found to be abnormally enlarged. In these cases where yolk sac was either enlarged or smaller in size, gestation terminated into abortion.

Background: Though human beings are thought to be singularly alike in their general anatomical construction, but when we come to investigate one particular region in detail, we frequently meet one or another type of variations. Muscles of the arm exhibit numerous variations. Commonest muscle of the arm to show variations is the biceps brachii. We are presenting series of variation of origin and number of heads of bicep brachi. Materials and Methods: 20 limbs were dissected as per the standard methods to note the origin, insertion and the nerve supply of the biceps brachii in the

Background:Intralesional bleomycin scelro-therapy has become a favored line of treatment for macrocystic lymphatic malformations. However the need for multiple sessions is a drawback associated with this treatment modality. Our aim is to document whether multiple session of intra- lesional sclero-therapy is necessary for complete resolution of cystic lymphatic malformation.Method:Intralesional bleomycin under Ultrasound guidance was used for macrocystic lymphangioma at concentration of 3mg/ml but not exceeding the total dose (1mg/kg) body weight for single session or cumulative dose of 5mg/kg. In all cases intralesional sclerosant (ILS) was installed under proper aseptic precaution in operation theatre in general anesthesia or sedation depending on the site or size of lesion and age of the patient. Age of patients at the time of enrolment in study ranged from 3 months to 18 years. Clinical examination was the main stay of diagnosis which was supplemented by USG and/or computed tomography. Compression of the lesion site was done for few hours wherever it was possible after the ILS session.Result:A total of 21 patients included in our study. The age ranged from 3 months to 18 years. Male to female ratio was 8:13. The most common site of involvement was neck and axilla followed by anterior chest wall and nape of the neck. Complete resolution after single session was observed in 90.5% cases where as surgery was required in 9.5% case. Major complication was observed in one patient, who had intralesional bleeding which was managed conservatively. Transient pain and fever was observed in 23.8% of cases. Only two patient required surgical intervention where one had persistent subcutaneous fibrotic nodule and other one did not respond to ILS.Conclusion:Intralesional bleomycin is an effective treatment for macrocystic lesion, and complete resolution may be achieved by single session of ILS if proper principle are followed.

Infantile Choledochal Cysts (IFCC) usually present with jaundice, acholic stool and abdominal lump or abdominal distension. If the surgical intervention is delayed, they rapidly progress to liver fibrosis which is considered to be irreversible if progressed to cirrhosis. We present the data of four cases (aged one month to seven months) of IFCC presented with cholangitis managed in one surgical unit in last two years. In one case, cholangitis was treated with prolonged antibiotic course before definitive repair whereas in rest, external drainage of cyst was done in addition to intravenous antibiotic to treat cholangitis. All the infants had features of cholangitis at time of presentation. Total leucocyte count ranged from 18x1000/UL to 30.6x1000/UL. Total bilirubin level at presentation ranged from 8.2 mg/dl to 18 mg/dl and Prothrombin time (INR) ranged from 1.33 to 1.9. Hepatic fibrosis was observed in all cases but cirrhosis was observed in only one case. There was no mortality but one patient had postoperative complication with prolonged hospital stay. External drainage helps in early recovery from cholangitis and better optimization of liver function. It also delays further progression to liver fibrosis by relieving the biliary outflow obstruction while waiting for definitive repair.

Introduction: Variation in neurovascular structure are commonly encountered in routine dissection. Brachial artery is the main artery of upper limb. In the arm, the median nerve passes at first lateral to brachial artery (near the insertion of coracobrachialis muscle), then crosses in front of the artery, descending medial to it in the cubital fossa. The knowledge of these variation could be helpful to vascular, plastic, general surgeons and orthopedicians. It is also important to prevent iatrogenic injuries. The aim of this study was to evaluate anatomical variations in course and relation of median nerve to brachial artery in the arm. Material & Methods: The study was conducted in 50 cadavers (100 upper limbs) in duration of two years. Proper cadaveric dissection was done in the Department of Anatomy, Dr. RML Institute of Medical Sciences, Lucknow, and Era’s Lucknow Medical College, Lucknow. Observation & Results: In the present series, median nerve was found to cross behind the brachial artery at about the middle of the arm in 8% cadavers. Median nerve entered the arm at first lateral to brachial artery, near the insertion of coracobrachialis. In 46 cadavers (96 upper limbs), it crossed in front of the artery from lateral to medial side. In four cadavers (5 upper limbs), it passed posterior to the brachial artery in the arm. Conclusion: Knowledge of the brachial artery and their variations are of clinical and surgical importance. An awareness of such a presence is valuable for the surgeons and radiologists in evaluation of angiographic images, vascular and re-constructive surgery or appropriate treatment for compressive neuropathies.