Multiple tendons of the abductor pollicis longus (APL) in the anatomical snuffbox of the wrist can lead to the development of de Quervain's syndrome, which is caused by stenosing tenosynovitis. A cadaveric study was performed to establish the variations present in the tendons of the anatomical snuffbox in a Malaysian population, in the hope that this knowledge would aid clinical investigation and surgical treatment of de Quervain's tenosynovitis.
Liver transplantation is the only solution for end-stage liver diseases. The common hepatic artery (CHA) arises from the coeliac trunk (CT), and the right (RHA) and left hepatic (LHA) arteries are its terminal branches. An abnormal arterial pattern would influence the surgical outcome. The anterior layer of the lesser omentum of a female cadaver was cleaned to identify the CHA, which was traced backwards for its origin and toward the porta hepatis for its terminal branches. In this case, the replaced RHA originated from the CT and ran posterior to the portal vein and the common bile duct. The replaced LHA arose from the left gastric artery. The CHA originated from the CT and branched out as the middle hepatic and gastroduodenal arteries. The replaced RHA and LHA with alteration in relation to the neighbouring structures is a complex and rare variant. Knowledge of this uncommon arterial anomaly is beneficial for hepatobiliary surgeons.
The presence of anatomical variations of the peripheral nervous system often accounts for unexpected clinical signs and symptoms. We report unusual variations of the lateral and posterior cords of the brachial plexus in a female cadaver. Such variations are attributed to a faulty union of divisions of the brachial plexus during the embryonic period. The median nerve lay medial to the axillary artery (AA) on both sides. On the right, the lateral root of the median nerve crossing the AA and the median nerve in relation to the medial side of the AA was likely the result of a faulty development of the seventh intersegmental artery. We discuss these variations and compare them with the findings of other researchers. Knowledge of such rare variations is clinically important, aiding radiologists, anaesthesiologists and surgeons to avoid inadvertent damage to nerves and the AA during blocks and surgical interventions.
INTRODUCTION:
This study assessed the information needs, preferred educational messages and channels of delivery, as well as opinions on strategies to promote organ donation. It aimed to provide insight into a culturally sensitive public education campaign to encourage organ donation in diverse ethnic communities in Asia, namely the Malays, Chinese and Indians.
METHODS:
A total of 17 focus group discussions with 105 participants were conducted between September and December 2008. The participants were members of the general public aged 18 to 60 years, who were recruited through convenient sampling in the Klang Valley area of Malaysia.
RESULTS:
Across ethnic groups, there was a general concern about the mistreatment of the deceased's body in the organ procurement process. The Chinese and Indian participants wanted assurance that the body would be treated with respect and care. The Muslims wanted assurance that the handling of a Muslim's body would follow the rules and regulations of the Islamic faith. The most important information requested by the Muslim participants was whether cadaveric donation is permissible in Islam. A lack of national public education and promotion of organ donation was noted. All the three ethnic groups, especially the Malays, required community and religious leaders for support, encouragement and involvement, as sociocultural influences play a significant role in the willingness to donate organs.
CONCLUSION:
The pronounced ethnic differences in information needs suggest that culturally sensitive public educational messages are required. Organ donation and transplantation organisations should work closely with community and religious organisations to address the sociocultural barriers identified.
We report a unique variation in the origin and branches of both the left and right external carotid artery (ECA) found during the dissection of a human cadaver. Knowledge of the possible anatomical variations of the ECA is especially important in facio-maxillary and neck surgeries. Surgeons need to be aware of the possibility of encountering such variations, as they may lead to difficulties in differentiating between the external and internal carotid arteries, and in identifying the branches and origins. This knowledge is also important for radiologists in the image interpretation of the face and neck regions.
Arthroscopy uses a completely different skill set compared with open orthopedic surgery. Hitherto, arthroscopy had not been given enough emphasis in the core orthopedic curricula. Simulation has been seen as an excellent way to teach the skills required in arthroscopy. The simulators used for arthroscopy training can be broadly classified into physical simulators such as cadavers, animals, models and box trainers, virtual-reality simulators, and hybrid simulators that combine virtual-reality simulation with physical components that allow real tactile feedback. The advantages and disadvantages of each of these types have been described in this article. The factors that determine skill acquisition using these simulators have been highlighted. In conclusion, simulation seems to be a valuable tool for arthroscopy training, although further studies are needed to state whether this translates into better operative skill on real patients.
The knowledge of vascular variations like other anatomical variations, is important during the operative, diagnostic, and endovascular procedures in abdomen. This report describes multiple variations in the upper abdominal vessels as found during the routine dissection in a 60-year-old male cadaver. The variations found were; presence of a celiaco-mesenterico-phrenic trunk, a common inferior phrenic trunk, 2 right renal arteries originating from abdominal aorta, 2 suprarenal arteries originating from the lower right renal artery, 3 right renal veins opening separately into inferior vena cava, and termination of right testicular vein into the lowest vein among the 3 right renal veins. The existence of a celiaco-mesenterico-phrenic trunk has not been reported yet. Although, other variations reported in this case exist as individual variations, a concomitant variation of them has not been reported yet. The knowledge of such variations is quite useful in planning any upper abdominal surgery.
In a forensic acarology study, conducted in a secondary forest of Forensic Science Simulation Site, Universiti Kebangsaan
Malaysia (UKM) in Bangi, Selangor, six carcasses consisted of three monkeys and three rabbits were placed individually
in steel enclosures and observed for 35 days. The carcasses, the soil beneath them and pitfall traps were checked daily
for insects and mites. A species of mesostigmatid mite, Macrocheles scutatiformis was discovered and this is a first time
reported in Malaysia. There are about 94.0% of Macrocheles present inside the cages of the monkey and rabbit carcasses.
Most mites in this study were collected from soil beneath the carcasses, on a dung beetle and a Chrysomya rufifacies
larva. Our findings showed that M. scutatiformis have a potential role in forensic investigation involving dead animals
perhaps corpses especially during the dry stage of decomposition.
Decomposition is degradation process of a corpse into basic respective constituents macroscopically and microscopically by action of microorganisms, arthropods and scavengers. Post mortem changes could be separated into early post mortem changes (i.e. algor mortis, rigor mortis and livor mortis) and putrefaction stages of corpse. These changes function as suitable indicators for determination of post mortem interval (PMI). In this paper, different stages of post mortem changes, possible variations such as mummification and formation of adipocere and special circumstances such as burial condition is discussed. This article also refers to several arguments in the different texture of adipocere and the influence of different types of fabric in affecting the post mortem changes and formation of adipocere. This is largely due to the property of permeability and resistance of material against degradation process. Undeniably, decomposition process involves numerous potential variables including burial condition, presence of clothing, potential formation of adipocere and mummification. Hence, studies in forensic taphonomy combined with real case scenario are crucial in understanding the nature of decomposition and estimation of PMI with higher accuracy.
This study was carried out in an oil palm plantation in Tanjung Sepat, Selangor in September 2007 by using pigs (Sus scrofa L.) as a carcass model in a forensic entomological research. A 2.5 month old pig (10 kg) which died naturally was hanged on a palm tree to observe the insect succession and decomposition stages. Observation was made for 16 days; one afternoon visit per day and all climatological data were recorded. On the first day, adult muscids of Ophyra spinigera Stein and Musca domestica L. were observed, however no blowfly (Calliphoridae) activities were sighted. Fly eggs wer seen on the second day on both sides of the face, inside nostrils and genitourinary area. Adults of Chrysomya megacephala Fabricius and Chrysomya rufifacies (Macquart) congregated on the head and anal areas. Adult flies and maggots (first and second instars) were observed in the mouth and anus of the pig on the third day of hanging. Adult yellow jackets (Vespidae) and spiders (Arachnida) were found preying on some adult flies. Rove beetles (Staphilinidae) were also discovered on the pig carcass. Only a few ants (Formicidae) were sighted. Maggot masses were found in eye orbits, neck, and genital organs on the fourth day of hanging and some maggots were seen falling down to the ground. The dominant maggot species identified on this day was Ch. megacephala. On the sixth day, the head, neck, and anus were in the stage of active decay. Maggots of Ch. rufifacies were abundant on the seventh day and was the dominant species. On day eight the carcass fell onto the ground. Chrysomya rufifacies maggots were found underneath the pig carcass and they started to migrate and pupated under the soil. On the tenth day, third instar Op. spinigera maggots were found under the carcass. The rate of carcass decomposition slowed down and became stable from tenth day onwards to the sixteenth day of decomposition. Thereafter, most of the remaining parts of the body remained dried and devoid of any insects.
Flies from the family Calliphoridae, Sarcophagidae and Muscidae are usually found on human cadavers or animal carcasses. However, there are many other families of Diptera and Coleoptera that were found associated with animal carcasses, which have not been reported in Malaysia. In this paper, we report dipterans from the family Micropezidae: Mimegralla albimana Doleschall, 1856, Neriidae: Telostylinus lineolatus (Wiedemann 1830); Sepsidae: Allosepsis indica (Wiedemann 1824), Ulidiidae: Physiphora sp. and a beetle (Coleoptera: Hydrophilidae: Sphaeridium sp.) as opportunist species feeding on oozing fluid during the decomposition process. They did not oviposit on the pig carcasses, therefore, their role in estimation of time of death is of little importance. However, they could provide clues such as locality and types of habitats of the crime scene.
The obturator artery (OA) originates from the internal iliac artery. Variation in the origin of the OA may be asymptomatic in individuals and occasionally be detected during routine cadaveric dissections or autopsies. In the present study, we observed the origin and the branching pattern of the OA on 34 lower limbs (17 right sides and 17 left sides) irrespective of sex. The bifurcation of the common iliac artery into internal and external iliac from the sacral ala varied between 4.3-5.3 cm. The distance of the origin of the anterior division of internal iliac artery from the bifurcation of common iliac artery varied between 1-6 cm. The distance of the origin of the posterior division of the internal iliac artery from the point of bifurcation of the common iliac artery varied between 0-6 cm. Out of 34 lower limbs studied, two specimens (5.8%) showed anomalous origin of the OA originating from the posterior division of the internal iliac artery. Of these two, one limb belonged to the right side while the other was from the left side. The anomalous OA gave off an inferior vesical branch to the prostate in both the specimens. No other associated anomalies regarding the origin or branching pattern of the OA were observed. Prior knowledge of the anatomical variations may be beneficial for vascular surgeons ligating the internal iliac artery or its branches and the radiologists interpreting angiograms of the pelvic region.
Peroneus tertius (PT) is a muscle of the anterior compartment of the leg. The PT muscle originates from the anterior surface of the fibula and the interosseous membrane and inserts into the medial side of the dorsal region of the fifth metatarsal bone. During routine dissection, we observed the absence of PT on the left lower limb of a cadaver. Usually, the PT is involved in dorsiflexion and eversion of the foot. In many cases, the absence of PT maybe asymptomatic and it may be incidentally detected during cadaveric dissections or autopsies. The existence of PT may help in the swing phase of bipedal walking. The PT may be used for tendon graft surgeries. The pull of the PT may be responsible for causing stress on the fifth metacarpal and account for all stress fractures in any individual. The absence of the PT may puzzle any transplant and foot surgeons performing graft operations. We as anatomists discuss the clinical implications of the absence of PT.
The present study examines the gross anatomical features of anomalous lunate sulcus detected incidentally in a cadaveric brain and discusses its clinical importance. The absence of lunate sulcus was carefully studied in a dissected brain specimen. The absence of lunate sulcus was observed unilaterally on the right side of a cadaveric brain specimen. The lunate sulcus was clearly appreciated on the left side whilst on the right side it was absent. The right hemisphere of the cerebellum was also bigger in size as compared to the left. The absence of lunate sulcus is a rare finding, which may be detected incidentally. The anatomical knowledge of the lunate sulcus may be important for neurosurgeons operating on the occipital lobe and the radiologists interpreting CT scan.
An abnormal communication between an artery and a vein is known as arteriovenous malformation (AVM) or arteriovenous fistula (AVF). The AVM or the AVF might be congenital in origin or even acquired. The arteriovenous communications are usually surgically made in patients undergoing repeated hemodialysis, while suffering from any chronic renal disease. The abnormal arteriovenous communications may be asymptomatic in nature. The arteriovenous communications might be an incidental finding during any anatomical dissections or medico-legal autopsies. The present study reports the presence of BBC on both sides of a 54-year-old male cadaver who died of road traffic accident. There was a communication between the brachial artery and the brachial vein, 11.5 cm above the medial epicondyle. The oblique communicating channel measured 1.5 cm in length and connected the brachial artery to the brachial vein. A detailed histological study of the communication showed the presence of thick tunica media. Knowledge of arteriovenous communications may be beneficial for any academic studies and equally important for vascular surgeons and radiologists performing angiographic studies.
During routine dissection classes to undergraduate medical students, we have observed some important anatomic variations in the right upper limb of a 45-year-old cadaver. The anomalies were superficial ulnar artery, persistent median artery, variant superficial palmar arch, third head for biceps brachii, accessory head for flexor pollicis longus, variant insertion of pectoralis major, absence of musculocutaneous nerve, coracobrachialis muscle supplied by lateral root of median nerve and anomalous branching of median nerve in arm and forearm. Although there are individual reports about these variations, the combination of these variations in one cadaver has not previously been described in the literature consulted. Awareness of these variations is necessary to avoid complications during radiodiagnostic procedures or surgeries in the upper limb.
In this article, we describe anomalous formation, distribution of superficial palmar arch and an arterial circle at the base of the thumb found during routine dissection classes in the right hand of a 45-year-old male cadaver. These variations are unique and provide significant information to surgeons dissecting the hand region.
This study assessed death anxiety (Death Anxiety Questionnaire, DAQ) and psychophysical- (psychological and physical) symptom experience following cadaveric dissection among the Silent Mentor Program (SMP) participants before thawing (T1), after the suturing, dressing and coffining session (T2), and one month post-program (T3). There was a significant decline in the total DAQ score comparing T1 and T2 (t = 7.69, p
Variation in the origin of long flexor tendons in the anterior compartment of forearm is common. During routine cadaveric dissection at Melaka Manipal Medical College (Manipal Campus), we observed a separate muscle belly and tendon of flexor digitorum superficialis (FDS) to the fifth digit in the right upper limb of a 60 year-old male cadaver. The anomalous muscle belly originated from the common flexor tendon from the medial epicondyle of the humerus and continued as a thin tendon at the middle of the forearm to get inserted into the middle phalanx of the fifth digit. This can be considered as a case of split flexor digitorum superficialis. Such muscle variations and knowledge of their frequency, appearance, and location can be helpful for surgeons.
The latissimus dorsi is a muscle of the back which forms the posterior fold of the axilla and its tendon twists to insert into the floor of the intertubercular sulcus of the humerus. Occasionally, the muscle has a muscular slip which crosses the axilla to insert into the pectoralis major. This muscular slip is often termed as "axillary arch." In the present study, we report bilateral axillary arch detected in a 45-year-old male cadaver. The average vertical length of the axillary arch measured 7 cm. The average maximum width of the uppermost, middle and lower part of the arch measured 2, 3.5 and 3.2 cm, respectively. The presence of the axillary arch is an uncommon finding in humans, considering the fact that it is solely found in the animals who prefer to hang on the trees. A histological study of the axillary arch was also performed and it showed skeletal muscle fibres which was uniformly arranged. The presence of the axillary arch may assist in the adduction of the shoulder. It may also compress the axillary vessels and nerves thereby causing resultant symptoms. Prior anatomical knowledge of the presence of axillary arch may be helpful for surgeons performing radical dissection of the axillary lymph nodes and ligation of axillary vessels, clinicians diagnosing abduction syndromes and interventional radiologists interpreting axillary mass in day to day clinical practice.