BACKGROUND Myocardial bridges are bands of cardiac muscle fibers, which bridges across the coronary arteries and its main branches. It is considered as a congenital anatomical variant mainly seen across the left anterior descending artery. Myocardial bridges may cause coronary heart disease either by compressing the underlying artery during cardiac systole or inducing atherosclerotic changes in the artery proximal to the myocardial bridge. The degree of coronary obstruction depends on the position, length, breadth and thickness of the muscle bridges. In this study, the myocardial bridges over the two coronary arteries and its main branches, gross anatomical changes of the tunnelled arteries and coronary dominance were observed. MATERIALS AND METHODS Ninety human heart specimens including five foetal were collected and fixed in 10% formalin. Coronary arteries were traced and myocardial bridges were looked for along the course of the artery and its position, type, measurements and dominance were tabulated. The gross features of the tunnelled arteries were also observed. RESULTS The incidence of myocardial bridges in 90 heart specimens was 63.3%. It is most prevalent in the middle third of the Left Anterior Descending (LAD) artery 61.4%. The percentage bridges over Posterior Descending Artery (PDA) 15.79, right coronary artery 7, left circumflex 8.77 and diagonal 7 were tabulated. The average length, breadth and thickness of MB in LAD was 38 mm x 10 mm x 2 mm. The largest and deep bridges were noticed over the diagonal artery with an average measurement of 45 mm x 25 mm x 20 mm. Right coronary dominance was observed in 77.12% hearts having MB. CONCLUSION Myocardial bridges are congenital anatomical variants and asymptomatic when it is thin and superficial. But, it produces coronary arterial compression and haemodynamic changes when it appears thick and deep. Myocardial bridges are more common in middle third of the LAD and also found in multiple sites in the same LAD and other branches. The association of right dominance with myocardial bridges in LAD may protect the myocardium from ischaemic changes.

BACKGROUND High origin and superficially placed ulnar artery is a rare anatomical variant that usually arises either in the axilla or arm and runs a superficial course in the forearm, enters the hand and participates in the formation of superficial palmar arch. During routine dissection of cadavers in our department, we observed a unilateral case of high origin and superficial ulnar artery in a human male cadaver. It originated from the brachial artery in the lower third of arm 4 cm above its bifurcation. From its origin, it passed downwards along the medial aspect of forearm, superficial to the flexors, entered hand superficial to the flexor retinaculum and formed superficial palmar arch. The knowledge of existence of a superficial ulnar artery is important during vascular and reconstructive surgery and also in evaluation of angiographic images. Superficial position makes it more vulnerable to trauma and more accessible to cannulation.

BACKGROUNDThe study of course and branching pattern of median nerve was done earlier by many researchers. The knowledge of median nerve in the hand got prime importance as it supplies motor and sensory branches to the thenar muscle and volar aspect of the hand. It passes through a restricted space under flexor retinaculum and is liable to get compressed. The nerve undergoes morphological changes under the retinaculum. It also shows variations in the course and distribution in the hand. This study is aimed at avoiding damage to the nerve and its main branches in hand surgeries like traumatic tendon surgeries, reconstructive hand surgeries and decompression procedures for carpal tunnel syndrome. MATERIALS AND METHODSFifty cadaveric human hands were dissected and median nerve were traced after cutting the flexor retinaculum. Branches were identified and photographed and the findings tabulated. RESULTSThe study of median nerve in fifty cadaveric hands show remarkable variation in the branching pattern. Median nerve shows flattening when it passes under flexor retinaculum. In 88% of hands, median nerve divides into medial and lateral branches distal to the flexor retinaculum, whereas 12% hands show early bifurcation proximal to flexor retinaculum. Thenar branches are given off from the lateral division and have an extraligamentous course in 80% of hands. Subligamentous course of thenar branch was seen in 12% of hands transligamentous course in 8%.Multiple accessory thenar branches were also observed arising from the base of proper digital branch to the thumb. Communicating branches were also observed with ulnar nerve seen in all cases at different sites. The first and second lumbrical muscles were supplied by median nerve, and in 10% hands, third lumbrical was also supplied by median nerve. Multiple thin vascular branches to superficial palmar arch were also observed. CONCLUSIONThis study throws light upon anatomical variations of median nerve while it passes under the flexor retinaculum, proximal to the retinaculum and distal to the retinaculum. Anticipation of such variations were helpful during hand surgeries to avoid iatrogenic damage of the nerve and its branches.

BACKGROUND Anatomical variations involving the visceral arteries are common. However, variations in coeliac trunk are usually asymptomatic, they may become important in patients undergoing diagnostic angiography for gastrointestinal bleeding or prior to an operative procedure. This study was useful for knowing the possible morphological variations before an upper abdominal surgery. MATERIALS AND METHODS This was a descriptive study done by cadaveric dissection, conducted on thirty cadavers. The coeliac trunk being examined for its origin, branching pattern, distribution, and variations. Results were statistically analysed and compared with the previous studies. RESULTS In our study, 60% of the coeliac trunk shows variations and 40% have normal branching pattern. A complete absence of coeliac trunk was observed in one case. In the present study the Right inferior phrenic artery arising from coeliac trunk in 2 cases (6.6%) and left inferior phrenic artery arising from coeliac trunk in 3 cases (9.9%). Both inferior phrenic arteries are arising from coeliac trunk in 2 cases (6.6%). The common hepatomesenteric trunk and gastro splenic trunk was found in 1 case (3.3%). Hepatosplenic trunk was found in 2 cases (6.6%). In another 2 cases (6.6%) gastric and hepatic artery originate from coeliac trunk but splenic artery has a separate origin from abdominal aorta. An absent trunk was also found in 1 case (3.3%). In 5 cases (16.7%) showed trifurcation with variation in the branching pattern. CONCLUSION The branching pattern and extreme degree variability in coeliac trunk as brought out in the observations of the present study make it obvious that the present study almost falls in description with previous studies.

BACKGROUND The coronary arteries are the biggest vasa vasora in the body since the heart is considered to be a modified blood vessel. The increased myocardial oxygen demand of the heart is met wholly by two coronary arteries. Hence, patients with coronary artery disease are prone to develop myocardial ischemia. The study is aimed at the structural changes of this vessels in the population of middle Kerala of various age groups from birth to seventy years. MATERIALS AND METHODS The specimen for histological study were fixed in 10% formalin and subjected to tissue processing. The sections were taken at the thickness of 5 microns and stained by using Haematoxylin-Eosin method and Verhoeff's method for elastic fibers. The thickness of arterial wall were measured using ocular micrometer. RESULTS Structural changes of the three layered vessel walls were observed. Intimal proliferation, splitting, fragmentation and reduplication of internal elastic lamina were the important histological observation in the arterial wall as age advances. It was observed that there was a sixty fold increase in the thickness of intima from foetal to sixth decade of life. Tunica media exhibit a six fold increase in thickness probably due to muscular hypertrophy. The tunica adventitia have a threefold increase in thickness which least compared with other tunics. CONCLUSION These changes may favour atherosclerosis resulting in myocardial ischemia. Ischemic heart disease is the major cause of death and disability among the age group of third to sixth decade of life.