During a routine dissection of the posterior triangle of the neck (right side) on a male cadaver, a variation related to the dorsal scapular nerve and long thoracic nerve was encountered. After firm identification of the variation, the region was dissected to reveal the full details of the course of dorsal scapular and long thoracic nerve, and the variation was photographed using an 8 megapixel digital camera. An atypical formation of dorsal scapular nerve [Table/ Fig-1] was seen, in the posterior triangle of the neck. The dorsal scapular nerve (DSN) which usually comes from the C5 root, had contributions from C5 and the C6 roots. The C5 component of the DSN pierced the scalenus medius muscle and divided into two branches within the muscle. The bigger branch ended by supplying the levator scapula muscle, while a smaller branch continued downwards and joined with a branch arising from the C6 root. On further dissection, it was found out that the two branches from the C5 and C6 roots united and coursed down as main trunk of dorsal scapular nerve. On the contrary, it was observed that the long thoracic nerve was formed by two components C6, C7 [Table/ Fig-1] mainly instead of three ventral rami of C5, C6, C7 cervical nerves. The C5 component of the long thoracic nerve was not apparently seen, but a communicating branch was given from C6 which seemed to carry fibres from C5. The C7 component was seen to arise from the middle trunk, which is a continuation of the ventral rami of the C7 spinal nerve. The C6 nerve root pierced the scalenus medius muscle and divided within the muscle into two smaller branches. The larger branch coursed down to join the C7 component of the long thoracic nerve (LTN), while the smaller branch coursed down to join a branch from the C5.Further, the brachial plexus as a whole was prefixed with contribution from the ventral rami of the 4 th cervical nerve [Table/ Fig-1], thus the upper trunk formed by the union of the C5 and C6 was thick and long. The Erbs point was identified and the nerve to subclavius and suprascapular nerves were also seen.A band of muscle fibers was further observed to connect the middle portion of the scalenus medius with the scalenus anterior muscle Pre and post-fixed variations at roots of the brachial plexus have been well documented, however little is known about the variations that exist in the branches which arise from the brachial plexus. In this paper, we describe about one such rare variation related to the dorsal scapular and the long thoracic nerve, which are the branches arising from the roots of the brachial plexus. The variation was found during routine dissection. The dorsal scapular nerve, which routinely arises from the fifth cervical nerve root (C5), was seen to receive contributions from C5 as well as sixth cervical nerve (C6), while the long thoracic nerve arose from C6 and seventh cervical nerves (C7) only. Furthermore along with variations in origin of the dorsal scapular and long thoracic nerves, the brachial plexus was seen to exist as a prefixed ...

Apical anterior vaginal wall prolapse (AVWP) with central defect is uncommon in young non hysterectomized patients causing considerable mortality after the fourth decade of life. Its high propensity to recurrence poses the greatest challenge to pelvic reconstructive surgeons. Approximately 40% of women with prolapse have hypertrophic cervical elongation and the extent of elongation increases with greater degrees of prolapse. Women with prolapse either have inherent hypertrophic elongation of the cervix which predisposes them to prolapse or the downward traction in prolapse leads to cervical elongation. The Pelvic Organ Prolapse Quantification (POP-Q) examination includes measurement of the location of the posterior fornix (point D) with the assumption that this measurement is associated with cervical elongation. Multifocal site involvement with apical and perineal descent primarily afflicts elderly, postmenopausal women after the fourth decade while cervical hypertrophic elongation with prolapse is observed in younger women less than 40 years of age. A review of the anatomical implication of the association of cervical hypertrophy in prolapse is carried out in this article. We observed a combination of distension type anterior vaginal prolapse with apical descent and cervical hypertrophy in a 20-year-old cadaver during routine dissection for undergraduate medical students at Sikkim Manipal Institute of Medical Sciences in 2013. Distension type anterior vaginal prolapse with central defect is rarer as most reported cases are of the displacement type, paravaginal defect. Hypertrophic cervical elongation is either the cause or consequence of prolapse and its identification before reconstructive surgery is paramount as uterine suspension in the face of cervical elongation is contraindicated. Inappropriate identification of all support defects and breaking of tissues is the primary cause of failure of laparoscopic pelvic reconstructive surgery.

BACKGROUND: The lordotic wedging and height of the presacral disc avert detrimental loads and shearing of the lumbar spine. Age and functional degenerations affect these causing spinal disarrays frequently requiring lumbar reconstructive surgery. Reinstating the disc height and wedging to its optimum healthy state is essential for accomplished spinal rehabilitation. The fourth and fth lumbar segments being most predisposed to mechanical pathophysiology and surgical interventions were evaluated in a north-east Indian population. MATERIALS & METHOD: The disc wedge angle, vertebral and disc heights and concavity index were measured in eighty lumbar segments comprising of twenty males and twenty females. RESULTS: The disc-wedge angle, anterior, middle, posterior disc heights and concavity index were as follows: 12.06±1.67°, 12.27±1.25mm,10.83±1.04mm,6.95±0.77mm,0.90±0.01at L4/L5 and 15.65±1.83°, 15.15±1.67mm, 11.32±1.68mm, 6.79±0.79mm, 0.90±0.01 at L5/S1 in males and 13.02±1.66°, 13.03±1.30mm, 11.86±1.23mm, 6.44±0.95mm,0.90±0.01 at L4/L5 and 16.89±1.71°,36.40 ±1.29mm, 16.04± 1.62mm, 12.31± 1.77mm, 6.06±0.94mm and 0.088 ± 0.02 in females. CONCLUSION: The disc wedge angles and anterior and middle disc heights were signicantly higher in females while the vertebral and posterior disc heights and convexity index were larger in males. The larger lordotic wedging of L5/S1 intervertebral disc preserves the spinal conformation. All above dimensions decreased with age in both genders. Our study standardizes quantitative referral data for research, diagnosis and prothesis to resolve the existing discordances.