Higher and bulkier origin of the lumbricals and their clinical relevance.

Lumbricals are important small intrinsic muscles of the hand, which arise from the tendons of the flexor digitorum profundus in the palm distal to the flexor retinaculum and are inserted on to the dorsal digital expansion. Variations in the unipinnate/bipinnate pattern of lumbricals, absence of one or more muscles, origin from the superficial flexor tendons and flexor retinaculum have been reported earlier. In the present case, all four lumbricals were arising from the tendons of the flexor digitorum profundus, proximal to the flexor retinaculum in the anterior part of the forearm and extending into the palm through the carpal tunnel. However, there was no variation found with regard to their normal unipinnate (first two) and bipinnate (last two) pattern of origin. In the palm all the four lumbricals were found to be bulkier than their normal size, first one being the bulkiest. The bulky and high origin of lumbricals within the carpal tunnel makes the tunnel a compact space. Therefore, such variation is one of the predisposing factors for the carpal tunnel syndrome. Thus, the knowledge of such variant origin of lumbricals is helpful not only during carpal tunnel release but also during the magnetic resonance imaging (MRI) and ultrasound based diagnosis of carpal tunnel and during the flexor tendon repair and reconstruction

Presence of additional head of pronator teres muscle and associated neurovascular variations: a rare case report

Arm is a site for frequent injuries and it is involved in many surgical procedures. Variations in the arm have immense clinical significance. During the dissection of a right upper limb, brachial artery was found to divide into radial and ulnar arteries, 3cm above the inter-epicondylar plane. The ulnar artery and the median nerve were then passing through a tunnel formed by an extensive additional humeral head of the pronator teres muscle. Two centimetres long fibromuscular tunnel formed by the humeral head of the pronator teres was found to arise from the medial intermuscular septum and also from the fibrous arch form the shaft of the humerus to the medial intermuscular septum. In the same cadaver, the superior ulnar collateral artery was found to arise from the profunda brachii artery which is otherwise a branch of the brachial artery. Accurate knowledge of these variation patterns is of considerable clinical significance in conduct of surgeries of arm, fracture management of humerus and diagnosis of various compressive neuropathies

Horse-shoe Shaped Kidney in Fetus: A Case Report

Horseshoe kidneys are found in 3% of the population and are probably the most common of all renal fusion anomalies. This anomaly consists of two distinct renal masses lying vertically on either side of the midline and connected at their respective lower poles by a parenchymatous or fibrous isthmus. In a male fetus, aged 32 weeks of gestation, horseshoe kidney was observed during anatomical dissection. Variations in the position of the ureter and the arterial supply were also noted. Although most cases of horseshoe kidneys are asymptomatic and discovered upon autopsy, the condition may increase the risk for ureteric obstruction, venacaval obstruction due to abnormal placement of ureter, renal infections associated with vesicoureteral reflux, renal stones due to deviant orientation of kidneys combined with slow urine flow and increased risk of renal cancer. [Med-Science 2015; 4(1.000): 1818-25

Abnormally rotated undescended testis arrested in the deep inguinal ring of an adult: A case report with histological study and review of literature

Normally testis is developed in the abdomen and descends in to the designated scrotal sac at the time of birth or within one or two years after birth. Several factors are associated with proper descent of the testis. Failure to descend, may lead to undescended testis or cryptorchidism. In the present case, we found an undescended testis partly in the inguinal canal and partly in the abdomen in a 71-year-old male cadaver. The epididymis descended first and its major portion was outside the superficial inguinal ring. The rest of the flattened epididymis was found inside the canal attached to the upper tapered pole of the testis and the vas deferens was found arising from this portion. The testicular vessels traversing through the deep inguinal ring then entered the postero-lateral portion of the tapered portion of the testis within the canal. No torsion and necrotic changes were observed in the undescended testis. Histological examination revealed a normal pattern in the epididymis which was outside the canal and a primitive duct system in the part of the epididymis within the canal. However, the entire testis showed only non-canalized smaller seminiferous tubules with very few cellular components and large inter-tubular spaces. The most common problems associated with such undescended testes are altered fertility, testicular cancer, inguinal hernia and testicular torsion with necrosis. Therefore, identifying the condition, evaluating the associated syndromes, proper diagnosis and therapeutic strategies are very important to prevent the adverse consequences mentioned above. [Cukurova Med J 2014; 39(3.000): 662-668