A Rare Case of Undescended Caecum Accompanied by Looped Retroperitoneal Appendix.

Intestinal malrotations are associated with various anatomical anomalies. We report a unique case wherein the caecum was located in the right lumbar region instead of the right iliac fossa. The ileo-caecal junction was also placed higher up. The appendix was ‘uncinate’ shaped, highly coiled and retroperitoneal with the absence of meso-appendix. Both, the caecum and appendix were supplied by ascending branch of the ileocolic artery instead of the descending branch. Further, we also observed that the ascending colon was very short and sub-hepatic in position. Such type of variations is of clinical and surgical importance in diagnosis and treatment of appendicitis

Trifurcated hepatic artery proper with unusual course and termination of right hepatic artery into fossa for gall bladder.

Variant vascular pattern affecting the hepatic artery is well documented. We here report a case of trifurcated hepatic artery proper associated with abnormal course, branching and termination of right hepatic artery. In the present case, hepatic artery proper trifurcated into right, middle and left branches about 2 cm before reaching porta hepatis. Left and middle braches entered the liver through the porta hepatis as normal but, the right hepatic artery took an unusual course towards the fossa for gall bladder and passed between portal vein behind and common hepatic duct, anteriorly. Just before its termination, it gave an additional hepatic branch to the liver and a cystic branch to the gall bladder. The rare course, branching pattern and abnormal termination of the right hepatic artery as reported here, are vulnerable to damage during intraoperative procedures if not carefully observed. Hence, prior knowledge of its variant anatomy is imperative during segmental resection of the liver and any intraoperative procedures performed in this region

Safety and Effectiveness of Total Thyroidectomy and Its Comparison with Subtotal Thyroidectomy and Other Thyroid Surgeries: A Systematic Review

Diseases associated with the thyroid gland are one of the most frequently seen endocrine disorders across the globe. Total thyroidectomy is currently the preferred treatment for many thyroid diseases. Controversies exist among surgeons regarding safety of total thyroidectomy due to the risk associated with it like postoperative hypoparathyroidism or recurrent laryngeal nerve damage. Since, in the recent years, the incidence of thyroidectomy is in increasing trend in south Indian population, this review aims to study the available data regarding the appropriateness and safety of total thyroidectomy and compares it with subtotal thyroidectomy and other thyroid surgeries. This is a retrospective comprehensive review of various articles and publications regarding total and partial thyroidectomy performed across the world. Many retrospective studies and few prospective studies suggest that the incidence of transient hypocalcemia is higher after total thyroidectomy than after subtotal thyroidectomy, but the incidence of other complications including recurrent laryngeal nerve palsy and postoperative hematoma is not significantly different between the two procedures. Hence in our review we found that total thyroidectomy is safe and cost effective with low complication rates and provides little significant advantage of being safer procedure compared to subtotal thyroidectomy

Abnormal intraparotid termination of facial vein and its clinical importance.

Facial vein is the main vein of the face. Though its origin is constant, it frequently shows variations in its termination. We report a rare type of variation of facial vein. The right facial vein coursed transversely across the masseter, superficial to the parotid duct and entered into the substance of the parotid gland, at its anterior border. Deep dissection of the gland revealed the abnormal termination of facial vein into the superficial temporal vein. The transverse facial vein drained into the facial vein. The superficial temporal vein after receiving the facial vein continued as retromandibular vein. Knowledge of this anomalous course and termination of facial vein may be important for the surgeons doing parotid, maxillofacial and plastic surgeries

Uncommon peritoneal anomaly of spleen associated with the unusual relationship of spleen with the left lobe of the liver.

Though congenital anomalies of the spleen are quite common, the peritoneal anomalies of the spleen are very rare. In the present case, we observed two unusual phrenico-splenic ligaments connecting the spleen to the diaphragm. Apart from this, the left lobe of the liver was elongated and was related to the diaphragmatic surface of the spleen. The splenic artery had a straight course to the spleen, indicating the possible restricted movements of the spleen. Knowledge of such unusual relation of spleen is essentially important for the surgeons as the elongated left lobe of the liver might get ruptured in addition to the spleen in the fractures of the left 9th, 10th and 11th ribs. Awareness of the straight course of the splenic artery is also of importance to Radiologists performing arterial splenoportography

Population structure in the Andaman keelback, Xenochrophis tytleri: geographical distance and oceanic barriers to dispersal influence genetic divergence on the Andaman archipelago

Limited gene flow between populations due to geographic distance, presence of barriers or inherent low dispersal ability leads to the formation of genetically structured populations. Strong population structure indicates lowered levels or absence of gene flow which might lead to inbreeding and loss of genetic capacity to recuperate from anthropogenic stress and natural calamities. Terrestrial reptiles are generally known to have low dispersal abilities and few studies have explored drivers of their population structure on continental islands, where both anthropogenic stress and natural calamities are relatively common. We investigated the population structure and drivers of diversification of the Andaman keelback (Xenochrophis tytleri), an endemic, terrestrial and freshwater snake species in the Andaman archipelago, a continental group of islands in the Bay of Bengal. Data was collected from 86 individuals from seven islands and 78 individuals were sequenced for the gene Nuclear Dehydrogenase subunit 4 to identify the number of populations and distribution of genetic diversity across populations. We found 11 haplotypes on seven islands and observed high genetic differentiation between seven populations defined island-wise (F-ST = 0.82). We further tested the number of populations by incorporating spatial data into Bayesian Clustering Analysis (GENELAND) and identified six populations of the Andaman keelback. We tested for the influence of Isolation-by-distance on these populations. While the overall trend showed a positive correlation between geographic and genetic distance, a correlogram revealed that the positive correlation disappears beyond -20-40 km. We also tested for the presence of geographical barriers to gene flow using Monmonier's algorithm (SPADS), which identified five barriers to dispersal confirming that there are oceanic barriers to dispersal for some island populations of the Andaman keelback. As the Andaman Islands are arranged almost in a straight line from North to South, our data are insufficient to tease apart the roles of geographical distance and barriers to gene flow. We conclude that salt waters between near islands are weak barriers and as the geographical distance between islands increases, so does the strength of the barrier

Atypical course of Maxillary Artery Piercing the Temporalis Muscle in the Infratemporal Fossa

Maxillary artery is one of the important contents of the infratemporal fossa. Reports on branching variations of the maxillary artery in the infratemporal region have been documented in the literature. We report in here a rare case of very superficial course of maxillary artery in the infratemporal fossa. The artery pierced the temporalis muscle from superficial to deep and divided the muscle fibers into superficial anterior and deep posterior parts. Entrapment of the maxillary artery within the muscle fibers may cause numbness or headache and may interfere with the injection of local anesthetics into the infratemporal fossa. Detailed knowledge of variations of maxillary artery in the fossa is of particular relevance in oral maxillofacial surgeries, management of epistaxis, intractable neuralgias or headaches

Short Axillary Vein and an Axillary Venous Ladder Formed by Basilic and Brachial Veins – An Anatomical and Clinical Perspective

Knowledge of anatomic variants of veins in the arm and axilla play a key role in planning of successful venous access. Possible anatomic variants of axillary vein, brachial vein and basilic vein and their clinical implications have been well described in the literature. We report a rare case of formation of a short axillary vein associated with complex venous communications between the basilic and brachial veins forming a venous ladder in the axilla, in formalin embalmed male cadaver. Axillary vein was formed in the upper part of the axilla by the fusion of basilic vein and unpaired brachial vein, and it was about 3cm in length. The higher-up confluence of basilic and brachial veins was also associated with presence of three communicating veins between the basilic and brachial veins in the axilla. Knowledge of reported venous variations is very useful during preoperative venous mapping and also for planning and execution of various surgical invasive procedures involving these veins

A unique case of bifid left testicular artery having its anomalous high origin from renal artery

The testicular arteries are known to originate from the ventrolateral aspect of the abdominal aorta and descend obliquely to the pelvic cavity and supply the testis. An anatomical description of an uncommon variation of the left testicular artery is presented in this case report, highlighting its clinical implications. During routine dissection of a male cadaver, we found that the left testicular artery was bifid and it was arising from the left renal artery. After its origin, it then coursed behind the left renal vein, passed between the left testicular vein and left ureter and at the lower pole of the left kidney, this bifid testicular artery joined to form a single testicular artery which thereafter presented a normal course. Anatomy of the testicular artery has been studied in detail because of its importance in testicular physiology, as well as its significance in testicular and renal surgery. This vascular variation shows a major significance in renal surgery, partial or total nephrectomy, and renal transplant. In addition, this anatomical variation enhances the importance of arteriography or the Doppler ultrasound examination of the renal hilum before surgeries