No abstract

he celiac trunk is the artery supplying the upper abdominal organs, mainly the lower part of esophagus, stomach, parts of duodenum, liver, gallbladder, spleen and pancreas. It normally trifurcates into the left gastric artery (LGA), the common hepatic artery (CHA) and the splenic artery (SA) at the superior border of the pancreas. This ‘normal variant’ of the vessel has been observed in 89.8 % cadaveric dissections in the Japanese population by Chen et al. (2009). Prakash et al. (2012) reported a normally trifurcating celiac trunk in 86 % of the south Indian population. The CHA branches from the celiac trunk, forms the gastroduodenal artery (GDA) and a proper hepatic artery (PHA), which further divides distally into right and left hepatic arteries. This normal origin and branching of CHA has been observed in 52–80 % of individuals (Michels 1966; Nelson et al. 1988; Hiatt et al. 1994; Koops et al. 2004; Chen et al. 2009). In a large series of 604 selective celiac and superior mesenteric angiographies, aberrant or anomalous vasculature was reported in 20.9 % of individuals by Koops et al. (2004). This knowledge and recognition of anomalous/aberrant or accessory vasculature in the upper abdomen, occurring in about one-fifth of the population is of vital importance to the hepatico-biliary-pancreatic surgeon to avoid iatrogenic injuries and complications, as well as to the interventional radiologist performing trans-arterial chemo-ablative procedures.

Sacral hiatus (SH) is a significant landmark during caudal epidural block (CEB) which is employed for analgesia and anaesthesia during a wide range of clinical conditions. This requires a thorough knowledge of morphometric characteristics of SH and surrounding landmarks, but variability in morphometric dimensions exists among different populations.Aim: The aim of this study was to identify different anatomical landmarks to detect the location of SH and provide a reference database for morphometric dimensions of SH in Indian population. Materials and Methods:The study was done on 108 dry adult human sacra. Linear measurements of the sacra were taken with the help of digital vernier caliper and angular parameters were determined with a goniometer. Results:The most common shape of the sacral hiatus was inverted 'V' shaped (59.3%) with the level of the apex at S4 in 66.7% and base at S5 in 86.1% cases. Morphometric dimensions of SH were found to be smaller in present study as compared to reports by other researchers. Left crest-apex angle was observed to be significantly greater than the right crest-apex angle. (p 0.001). Conclusion:Multiple bony landmarks and their morphometric dimensions should be considered to locate the SH during CEB. Values for various morphometric parameters of SH are less in Indians in comparison to other populations, which should be contemplated during caudal epidural injections and trans-sacral thecaloscopy.

A variant course and branching pattern of the right brachial artery was recorded in a 54-year-old male cadaver during the practical sessions of University College of Medical Sciences, Delhi, India. The right brachial artery divided in the middle third of arm into a medial superficial and lateral deep branch. The superficial medial branch descended anterior to the median nerve and ended by dividing in the cubital fossa into ulnar and radial arteries, whereas the lateral branch descended postero-medial to the median nerve, ending deep to pronator teres as the common interosseous artery. The left brachial artery showed a normal branching pattern by dividing into radial and ulnar arteries in the cubital fossa. The probable origin of such a variation is embryological and familiarity with such variations is imperative as they might affect dynamics of limb function or alter the course of interventional procedures. [Int J Res Med Sci 2013; 1(2.000): 62-65