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Riedle's lobe of liver and its clinical implications
Abstracts / Journal of the Anatomical Society of India 66S (2017) S79–S125
Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.jasi.2017.08.331 86 A novel approach to measure the carpal tunnel in cadavers Melanie Dsouza ∗ , Anil K. Bhat, Sneha Melaka Manipal Medical College (Manipal Campus), Manipal, India Introduction: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy in the upper extremity, with a lifetime risk of approximately 10 percent. Anatomical factors have been identified to contribute to the etiology of CTS. Many methods have been employed towards the study of the morphometry of the carpal tunnel. However, these methodologies have been questioned with time for accuracy by recent literature. The main objective of the study was to define the method to be employed in outlining the morphological dimensions of the carpal tunnel in cadavers. Methods: 10 cadavers were used for this study. The hands were dissected to expose the flexor retinaculum and its attachment site. Carpal tunnel contents were then evacuated, and carpal tunnel mold was created using Plaster of Paris (POP). These molds were then scanned by a 3D scanner. The 3D reconstructed carpal tunnel image was then evaluated for length, width, depth and crosssectional area along the length of the tunnel. Results: There was no significant difference between the tunnel measures of the right and left hand. However, each hand presented significant difference in width, height and cross-sectional area from the inlet to the outlet along the length of the tunnel. Conclusion: Present findings suggest that the tunnel is cone shaped, narrowing towards the outlet. The shape of the tunnel was irregular as the ulnar aspect shows more depth than the radial aspect. Conventionally caliper methodologies are used in the quantitative analysis of human anatomy. The present study demonstrates the use of computer technology for developing 3D structure of the carpal tunnel which is reproducible and can be measured accurately. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.jasi.2017.08.332 87 Riedle’s lobe of liver and its clinical implications Minal Ravat ∗ , Heena Chaudhari, V.H. Vaniya Government Medical College, Baroda, India Introduction: The liver is largest abdominal viscera located in right hypochondrium, epigastrium, left hypochondrium in upper abdominal cavity. Riedle’s lobe, a rare anatomical variation of liver first described by Riedle in 1888. It is a tongue like projection of the right lobe of the liver, has been described as an accessory lobe but it is not a true hepatic lobe. Clinical significance of Riedle’s lobe has been identified as its inclusion in differential diagnosis of Right sided abdominal palpation masses.
S105
Materials and method: During routine dissection of abdomen, the abdominal cavity is opened and liver was removed in the Department of Anatomy, Medical College, Baroda, Gujarat. Different variations in lobes, and accessory lobes on the surface of the liver were observed. Results/observations: Accessory lobe of liver is a rare finding which may not produce any sign or symptoms but sometimes the mass is consider as a tumor. In the specimen there is a presence of additional tongue like-projection from right lobe of liver towards the umbilicus was observed. Discussion/conclusion: Knowledge of such variation may be helpful for surgeons, radiologist to avoid possible errors in interpretations and subsequent misdiagnosis, and to assist in planning appropriate surgical approaches. These variations assume more importance with advances laparoscopic surgery of liver and thermal ablation for patients with hepatic tumor. It does not always remain clinically latent in case of its torsion or hepatic tumors including metastasis or hepatocellular carcinoma may sometimes arise only in the lowest part of Riedel’s lobe. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.jasi.2017.08.333 88 Unusual branching pattern of left gastric artery – A case report K.G. Mohandas Rao ∗ , S.N. Somayaji, L.S. Ashwini, Sapna Marpalli Melaka Manipal Medical College, Manipal University, Manipal, India Introduction: The left gastric artery usually arises from the celiac trunk and supplies cardiac end of stomach and lower part of esophagus. Inferior phrenic artery arises from the abdominal aorta at the level of T12 vertebra and supplies inferior surface of diaphragm and suprarenal glands. It has been reported that only in 3% of cases inferior phrenic artery arises from left gastric artery. However, left gastric artery as a source of left superior suprarenal artery is not been reported. Observation: During routine cadaveric dissection at Melaka Manipal Medical College (Manipal Campus) for the first year medical students, we observed a variation in the branching pattern of left gastric artery. The left gastric artery after arising from the celiac trunk formed a loop towards lesser curvature of the stomach and supplied the stomach. In addition, it gave an accessory branch close to the cardiac end of stomach which also formed a similar loop distal to the loop of the left gastric artery and ended by supplying the fundic region of the stomach. This accessory branch also gave the left inferior phrenic artery and left superior suprarenal artery. The left inferior phrenic artery further divided into smaller branches to supply the inferior surface of diaphragm. The left superior suprarenal artery ended by supplying the left supra renal gland. Inferior phrenic angiography is one of the diagnostic tools in case of hepatocellular carcinoma as it acts as an extrahepatic collateral arterial supply for the malignant mass. Conclusion: Knowledge of such a variation in the branching pattern of left gastric artery and the inferior phrenic artery is clinically significant for the trans-catheter chemo-embolization of hepatocelluler carcinoma, invasive radiological procedures
Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.jasi.2017.08.331 86 A novel approach to measure the carpal tunnel in cadavers Melanie Dsouza ∗ , Anil K. Bhat, Sneha Melaka Manipal Medical College (Manipal Campus), Manipal, India Introduction: Carpal Tunnel Syndrome (CTS) is the most common entrapment neuropathy in the upper extremity, with a lifetime risk of approximately 10 percent. Anatomical factors have been identified to contribute to the etiology of CTS. Many methods have been employed towards the study of the morphometry of the carpal tunnel. However, these methodologies have been questioned with time for accuracy by recent literature. The main objective of the study was to define the method to be employed in outlining the morphological dimensions of the carpal tunnel in cadavers. Methods: 10 cadavers were used for this study. The hands were dissected to expose the flexor retinaculum and its attachment site. Carpal tunnel contents were then evacuated, and carpal tunnel mold was created using Plaster of Paris (POP). These molds were then scanned by a 3D scanner. The 3D reconstructed carpal tunnel image was then evaluated for length, width, depth and crosssectional area along the length of the tunnel. Results: There was no significant difference between the tunnel measures of the right and left hand. However, each hand presented significant difference in width, height and cross-sectional area from the inlet to the outlet along the length of the tunnel. Conclusion: Present findings suggest that the tunnel is cone shaped, narrowing towards the outlet. The shape of the tunnel was irregular as the ulnar aspect shows more depth than the radial aspect. Conventionally caliper methodologies are used in the quantitative analysis of human anatomy. The present study demonstrates the use of computer technology for developing 3D structure of the carpal tunnel which is reproducible and can be measured accurately. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.jasi.2017.08.332 87 Riedle’s lobe of liver and its clinical implications Minal Ravat ∗ , Heena Chaudhari, V.H. Vaniya Government Medical College, Baroda, India Introduction: The liver is largest abdominal viscera located in right hypochondrium, epigastrium, left hypochondrium in upper abdominal cavity. Riedle’s lobe, a rare anatomical variation of liver first described by Riedle in 1888. It is a tongue like projection of the right lobe of the liver, has been described as an accessory lobe but it is not a true hepatic lobe. Clinical significance of Riedle’s lobe has been identified as its inclusion in differential diagnosis of Right sided abdominal palpation masses.
S105
Materials and method: During routine dissection of abdomen, the abdominal cavity is opened and liver was removed in the Department of Anatomy, Medical College, Baroda, Gujarat. Different variations in lobes, and accessory lobes on the surface of the liver were observed. Results/observations: Accessory lobe of liver is a rare finding which may not produce any sign or symptoms but sometimes the mass is consider as a tumor. In the specimen there is a presence of additional tongue like-projection from right lobe of liver towards the umbilicus was observed. Discussion/conclusion: Knowledge of such variation may be helpful for surgeons, radiologist to avoid possible errors in interpretations and subsequent misdiagnosis, and to assist in planning appropriate surgical approaches. These variations assume more importance with advances laparoscopic surgery of liver and thermal ablation for patients with hepatic tumor. It does not always remain clinically latent in case of its torsion or hepatic tumors including metastasis or hepatocellular carcinoma may sometimes arise only in the lowest part of Riedel’s lobe. Conflicts of interest The authors have none to declare. http://dx.doi.org/10.1016/j.jasi.2017.08.333 88 Unusual branching pattern of left gastric artery – A case report K.G. Mohandas Rao ∗ , S.N. Somayaji, L.S. Ashwini, Sapna Marpalli Melaka Manipal Medical College, Manipal University, Manipal, India Introduction: The left gastric artery usually arises from the celiac trunk and supplies cardiac end of stomach and lower part of esophagus. Inferior phrenic artery arises from the abdominal aorta at the level of T12 vertebra and supplies inferior surface of diaphragm and suprarenal glands. It has been reported that only in 3% of cases inferior phrenic artery arises from left gastric artery. However, left gastric artery as a source of left superior suprarenal artery is not been reported. Observation: During routine cadaveric dissection at Melaka Manipal Medical College (Manipal Campus) for the first year medical students, we observed a variation in the branching pattern of left gastric artery. The left gastric artery after arising from the celiac trunk formed a loop towards lesser curvature of the stomach and supplied the stomach. In addition, it gave an accessory branch close to the cardiac end of stomach which also formed a similar loop distal to the loop of the left gastric artery and ended by supplying the fundic region of the stomach. This accessory branch also gave the left inferior phrenic artery and left superior suprarenal artery. The left inferior phrenic artery further divided into smaller branches to supply the inferior surface of diaphragm. The left superior suprarenal artery ended by supplying the left supra renal gland. Inferior phrenic angiography is one of the diagnostic tools in case of hepatocellular carcinoma as it acts as an extrahepatic collateral arterial supply for the malignant mass. Conclusion: Knowledge of such a variation in the branching pattern of left gastric artery and the inferior phrenic artery is clinically significant for the trans-catheter chemo-embolization of hepatocelluler carcinoma, invasive radiological procedures