Anatomical variations in the extra hepatic biliary system: a cross sectional study

Background: The anatomy of the biliary system has been the subject of extended research for many years. Largely because of their surgical importance in cholecystectomies and the ease with which they may be studied. Though, interest has been focused on the extrahepatic bile ducts very few studies have been carried out in the Indian subcontinent. Objectives was to study the anatomical variations in extrahepatic biliary system in sample of Indian cadaveric specimens.Methods: The study material consisted of 20 adult dissection room cadavers and 30 enbloc post-mortem specimens. Cadaver specimens were studied from dissection room. Post-mortem enbloc specimens were collected from the Department of Forensic Medicine, Madurai Medical College, Madurai. They were studied by conventional dissection method.Results: The key abnormalities found in all bladder were Hartman's pouch shape and neck in 2 (4%) subjects each. Gallstones were present in 2 (4%) subject. The length of the common Bile duct was ranging from as short as 6.5 cm in 24% of the subjects to 9cm in 4% of the subjects. High level of the cystic duct union with the common hepatic duct was noted in16% of specimens and in remaining 2% it was low union. Abnormal arrangement of structures in hepatoduodenal duct was normal in 98% but was abnormal in 2% of subjects. A total of 14% of the specimens had accessory ducts. Double and accessory cystic artery was found in 2% of the subjects each.  In 8% of the subjects, cystic artery had abnormal course and division. The right hepatic artery was had shown abnormal course and division in 4% of the subjects. Abnormal boundaries of Calot’s triangle was found in 2% of the subjects. Abnormal contents of Calot’s triangle include Accessory hepatic ducts in 10% of subjects.Conclusions: Anatomical variations of the extrahepatic biliary system are very common and a through an understanding of them is essential for surgeons to avoid damage to vital structures during surgical procedures and better surgical outcomes

Study of extrahepatic biliary apparatus

INTRODUCTION: The study of extra hepatic biliary system is not only interesting but also useful to operating surgeons and radiologist. Recently increased rate of recent advances like “Living donor liver transplantation with duct to duct anastomosis and cholecystectomies performed by laproscopic procedures has made it imperative that the surgeon should have an adequate knowledge of the normal anatomy and its variations of extra hepatic biliary system. Recent investigations like magnetic resonance cholangio pancreatography (MRCP) require definitive knowledge about the anatomy of ductal system. The gall bladder plays an important role in the metabolisms of bile salts and subsequently that of fat. The gall bladder in addition to congenital anomalies has various metabolic, endocrine, obstructive, inflammatory and malignant diseases. In United States about 15% of population suffered from biliary tract disease (Cliason and Stevena in 1994) and this increased about 30% after the age of 45 and above. The gallstone obstructing the passage results in surgery about 80% of operations done upon gall bladder and bile ducts. The gall bladder has been an organ of speculation since the times immemorable. Jacopo da carpi (1522) “sometimes a man lack gall bladder; he is then of infirm health and shorter life. AIM OF THE STUDY: In no region of the human body is anomaly so common as in the biliary ducts and its adjacent blood vessels. In analysis of the literatures, many investigations have been carried about the variational anatomy of extra hepatic biliary apparatus. The importance of the variational anatomy of the extra hepatic duct system and its related vessels, in operative and invasive procedures, was first predicted by “Schachner” (1916). Abnormalities of the major ducts and accessory hepatic duct during Cholecystectomy is the most frequent cause for postoperative complications such as leakage of bile, fistula, necrosis of liver and hepatic failure. Biliary peritonitis leads to more serious trouble, if unrecognized during surgery. Similarly, arterial variations give rise to frequent hemorrhage during surgery. They may lead to injuries to duct, as during the process of clamping the anomalous vessels, ducts can also be included in ligature along with artery. Moreover, recognition of the structures in the calot’s triangle is considered to be important to minimize injuries of bile ducts and their related vessels. Narrow exposure and variational anatomy are the two major things that contribute to operative difficulties to the surgeons. It is like wise true, that anatomical knowledge is critical to prevention of injuries of the structures in hepatoduodenal ligament for interpretation of cholangiograms like Percutaneous Transhepatic Cholangiography (PTCA), Endoscopic Retrograde Cholagio Pancreatography (ERCP) and Magnetic Resonance Cholangio Pancreatographic (MRCP) procedures. The importance of variations in the extrahepatic biliary ductal system and calot’s triangle has been much observed by the surgical gastroenterologist, radiologist and general surgeons. Such an extensive clinically oriented topic created much interest in me which in turn provoked me to dissect and analyse the variations in extrahepatic biliary apparatus. MATERIALS AND METHODS: The study material consisted of: 1. 20 adult dissection room cadavers. 2. 30 enbloc postmortem specimens. Specimen collection: 1. Cadaver specimens were studied from dissection room. 2. Postmortem enbloc specimens were collected from the Department of Forensic Medicine, Madurai Medical College, Madurai. They were studied by conventional dissection method. The autopsies had been carried out by laparotomy midline incision from xiphisternum towards umbilicus. Incision extended laterally, from xiphisternum along the costal margin. Rectus muscle cut open in the midline. Peritoneum opened and entered into abdominal cavity. Stomach identified and its curvatures were defined. Pulling the lesser curvature, lesser omentum identified and its right free margin was defined and then hepatoduodenal ligament was identified. Now the greater omentum was cut transversely below it was pushed forwards towards right. Coils of small intestine was pushed towards left and 2nd part of duodenum was exposed and two ligature were put, one at the pyloric end of stomach and second just below 2nd part of duodenum. CONCLUSION: After studying 50 specimens’ of extrahepatic biliary apparatus, I have come to the following conclusion as follows. • A single gall bladder, extra hepatic, lodged in the fossa for the gall bladder, covered with peritoneum only on the posterior surface, with rugae in the interior was observed, in all the cases. Supernumerary gall bladder, intra hepatic gallbladder, left sided gall bladder, floating gall bladder, diverticula of gall bladder, phyrgian cap and septate gall bladder, although occasionally reported earlier was not noted in present study. • Hartman’s pouch was found in 4% in this study as a variation in the shape. • Extrahepatic union of right and left hepatic ducts to form the common hepatic duct was noted in 64% of cases, which appeared to be more common than intrahepatic union. • Cystic duct joins the common hepatic duct as an angular type in 80% cases. • Cystic duct joins the common hepatic duct at a point in which it makes common hepatic duct shorter and common bile duct longer. This is consider as normal level of union. • The average length of the ducts observed in the study are cystic duct 2 to 4 cms, common hepatic duct 1.5 to 3.5 cms and common bile duct 5.5 to 8 cms. • The arrangement of structures in hepatoduodenal ligament was that, common bile duct lies anterior and to the right of the ligament, hepatic artery lies anterior and to the left of duct system and portal vein larger and posterior to these structures. • The frequency of occurrence of accessory ducts was 14%. • The most commonly occurring ductal variations are presence of accessory right hepatic ducts terminating anywhere in common hepatic duct. • Cystic artery arising from the right hepatic artery is seen inside the calot’s triangle dividing into superficial and deep branches to supply the respective surfaces of gall bladder is noted to be the commonest arrangement. • Right hepatic artery arises from hepatic proper and seen to the left side of duct system. • Both cystic and right hepatic arteries passing posterior to the common hepatic duct to reach the calot’s triangle is seen to be more common. Hence many variations have found in this study, I believe the understanding of these variations is important not only for the anatomists, but definitely useful for operating surgeons and radiologist

Design of optimized fuzzy logic controller for area minimization and its

Abstract: Area optimization is one of the important problems in reconfigurable systems. A Field-programmable gate array (FPGA) based optimised Fuzzy Logic Controller(FLC) has been developed for speed control of DC Motor by exploiting the basic features of Fuzzy logic. The aim of the proposed scheme is to reduce the area, as compared with conventional Fuzzy Logic Controller. The area of a design refers to sum of the area space of the circuit components in FPGA. To implement optimised Fuzzy Logic Controller certain modifications have to made, such that its functionality is identical to original design but requires a smaller area. Real time implementation of Optimised FLC and conventional FLC are made on Spartan-3A DSP FPGA (XC3SD1800A) reconfigurable FPGA for the speed control of DC motor. Results shows that area needed to implement the proposed scheme is reduce drastically and while maintaining the same performance

Phase I-Designing a biofeedback device for quadriceps re-education-bridging the gap in exercise compliance

529-532Knee Osteoarthritis is a painful and disabling condition which causes difficulty in activities of daily living. Such patients are referred for physiotherapy sessions where they were prescribed with exercises as home programs, quadriceps isometrics was the commonly prescribed exercises as it causes the least intraarticular inflammation than other types of exercises. Research reports poor compliance to the exercise program with lack of confidence and doubt of performing correctly were being commonly reported answers to the lack of compliance. With the idea to improve the compliance to the exercise program this device is developed which helps the patients to perform the exercises at home and improve their confidence levels too. The Microcontroller used is Arduino Mega 2560 and Force sensor. Force sensor is used to sense the force produced by the patient and MCP6004 operational amplifier is used as Voltage follower for providing the exact voltage. It also has audio feedback and visual feedback, Audio feed back is given by connecting a voice playback module and a buzzer and visual feedback is given by LED’s of three colours- red, yellow, blue. LCD also displays the time taken by the patients. This device will surely improve the compliance with exercises for the wellbeing of patient

Impact of blockchain technology adoption in farms of FPO members

BCT adoption remains to be a promising way to achieve food security and safety in many developing countries. This paper explores the impact of blockchain technology adoption on household farm income. Based on a simple random sampling method, a cross sectional survey was conducted in the year 2023 to collect data from 240 sample farmers including 120 BCT adopters and 120 non-adopters in Erode district of Tamil Nadu. The information regarding socio-economic profiles like age, gender, educational status, farming experience, farm size, extension agency contact, training programmes attended, access to technological information were collected from sample farmers through personal interviews. The present research used a treatment effect analysis with propensity score matching approach to assess the impact of blockchain technology adoption on household’s farm income. Results showed a significant increase in farm income as a result of blockchain technology adoption among sample farmers. PSM approach estimated that the blockchain technology adopters earned higher farm income of ₹25829.16 as compared to non-adopters. Hence the findings provide empirical evidence that blockchain technology adoption in agriculture can contribute to improve quality food production and enhance farm income

The Influence Of Maternal Infections On Congenital Heart Defect

ABSTRACT Congenital heart defects (CHDs) contribute significantly to heightened infant mortality rates. This review explores the intricate link between maternal infections and CHDs, emphasizing diverse factors influencing fetal development, such as bacterial, fungal, protozoan and viral agents. These infections pose reproductive health risks, potentially leading to complications like prematurity, stillbirth and heart defect to the fetus. The TORCH acronym (Toxoplasma, Other infections, Rubella, Cytomegalovirus, Herpes simplex) identifies infectious teratogens related to congenital issues, emphasizing vertical transmission through the placenta or ascending from the vagina. Rubella and Cytomegalovirus play a significant role in heart defects, particularly when maternal infections amplify CHD risk during pregnancy. Specific scrutiny is placed on Rubella and Cytomegalovirus for their impact on pregnancy outcomes and potential links to congenital heart defects, with preventive strategies discussed, including vaccination and antiviral therapy. The timing and severity of these infections are pivotal in determining their impact on fetal heart development. Environmental exposures and maternal nutrition are critical factors influencing fetal development. Maternal undernutrition in low- and middle-income countries associates with adverse pregnancy outcomes, including congenital heart defects. Emphasizing the importance of maintaining a nutritious maternal diet, rich in essential nutrients, is crucial for improved fetal health and successful pregnancy outcomes. This review offers insights into preventive measures and underscores the need for continued research to enhance prenatal care strategies

Youth futures and a masculine development ethos in the regional story of Uttarakhand

Research on the Uttarakhand region, which became a new state in 2000, has focused largely on agrarian livelihoods, religious rituals, development demands, ecological politics and the role of women in regional social movements. This essay discusses another dimension of the regional imaginary—that of a masculine development ethos. Based on ethnographic research and print media sources, this essay focuses on stories, politics, mobilities and imaginations of young men in the years immediately after the achievement of statehood. Despite increased outmigration of youth in search of employment, many young men expressed the dream of maintaining livelihoods in the familiar towns and rural spaces of Uttarakhand, describing their home region as a source of power and agency. In rallies and in print media, young (mostly upper caste) men expressed their disillusionment with the government and the promises of statehood, arguing that their aspirations for development and employment were left unfulfilled. Gendered stories of the region, told in Hindi in rallies and print media, contained references to local places, people and historical events and were produced through local connections and know-how, fostering a regional youth politics. The article argues that Uttarakhand as a region is shaped by the politics of local actors as well as embodied forms of aspiration, affiliation and mobility.IS