Bailey & Love's Short Practice of Surgery

A detailed knowledge of the gall bladder and bile ducts (together with their anatomical variations) and related blood supply are essential in the safe performance of both open and laparoscopic cholecystectomy as well as the interpretation of radiological and ultrasound images of these structures. These topics are described and illustrated.

The gall bladder and bile ducts

Introduction The lungs have three main fissures: the right oblique fissure (ROF), right horizontal fissure (RHF), and left oblique fissure (LOF). These can be complete, incomplete or absent; quantifying the degree of completeness of these fissures is novel. Standard textbooks often refer to the fissures as complete, but awareness of variation is essential in thoracic surgery. Materials and methods Fissures in 81 pairs of cadaveric lungs were classified. Oblique fissures were measured from lung hila posteriorly to the lung hila anteriorly; and the RHF measured from the ROF to the anteromedial lung edge. The degree of completeness of fissures was expressed as a percentage of the total projected length were they to be complete. The frequency and location of accessory fissures was noted. Results LOF were complete in 66/81 (81.5%), incomplete in 13/81 (16.0%) and absent in 2/81 (2.47%); ROF were complete in 52/81 (64.2%), incomplete in 29/81 (35.8%) and never absent; RHF were more variable, complete in 18/81 (22.2%), incomplete in 54/81 (66.7%) and absent in 9/81 (11.1%). LOF and ROF were on average 97.1% and 91.6% complete, respectively, being deficient posteriorly at the lung hila. The RHF on average 69.4% complete, being deficient anteromedially. There were accessory fissures in 10 left and 19 right lungs. Conclusions This study provides a projection of the anatomy thoracic surgeons may encounter at operation, in particular the variable RHF. This knowledge is essential for optimal outcomes in both benign and oncological procedures influenced by the fissures.

Are textbook lungs really normal? A cadaveric study on the anatomical and clinical importance of variations in the major lung fissures, and the incomplete right horizontal fissure

Introduction: The detection of pelvic mass with associated raised CA 125 level is highly suspicious for ovarian cancer, but there are various other benign pelvic pathologies that mimic the above fi ndings, especially in premenopausal women in the Indian subcontinent as seen in our case series. Purpose: Purpose of the study was to look for different benign pelvic masses associated with raised level of CA 125. Materials and Methods: It was prospective study in which cases of pelvic mass with raised CA 125 level that turned out to be benign in etiology on complete work up were evaluated and followed up on treatment at 2 months of interval with serial measurement of CA 125. Result: Out of 15 cases of benign pelvic masses with raised CA 125 level, 10 cases were of genital tuberculosis and associated pelvic infl ammatory disease, 4 cases were of endometriotic cysts, and 1 case was of ruptured dermoid cyst of ovary. All cases showed a signifi cant reduction in CA 125 level on follow-up at 2 months. Conclusion: There are various benign pelvic masses that are associated with raised CA 125 level. Detailed clinical history and radiological investigations can be helpful in arriving at a correct diagnosis. This is more important in India subcontinent where genital tuberculosis and pelvic infl ammatory disease are common.

/pdf/benign-pelvic-masses-associated-with-raised-ca-125-level-36h4sb2yc6.pdf

Benign Pelvic Masses Associated with Raised CA 125 Level: Radiological Pathological Correlation

Introduction: The lungs are a pair of vital organs of respiration which are divided into lobes by fissures. The fissures facilitate the movements of lobes and help in uniform expansion of the whole lungs. The fissure may be complete, incomplete, or absent. The knowledge of position and completeness of fissures and lobes is necessary for an appreciation of lobar anatomy and thus locating bronchopulmonary segments. Objectives: The objective of this study was to analyze the morphology of fissures and lobes of lungs. Materials and Methods: Twenty pairs of lungs were taken for the study, obtained from twenty formalin-fixed cadavers. The specimens were thoroughly observed for the pattern of lobes, fissure variations were noted, and the specimens were photographed. Results: Of the twenty right-sided lungs, incomplete oblique fissure was seen in six (30%) lungs. None of the lungs showed the absence of oblique fissure. Incomplete horizontal fissure was seen in ten (50%) lungs, and horizontal fissure was found absent in four (20%) lungs. Among the twenty lungs, four (20%) lungs showed two lobes due to the absence of horizontal fissure and the remaining 16 (80%) lungs showed normal lobar pattern of lungs. On the left side, incomplete oblique fissure was observed in two (25%) lungs, and two (25%) lungs showed the absence of oblique fissure. Due to the absence of oblique fissure, three (15%) specimens showed only one lobe while 17 (85%) lungs showed normal lobar pattern. There was no incidence of the presence of an accessory fissure in either side of the lungs. Conclusion: The present study when compared with a previous work showed a wide range of difference in the lobes and fissures between and among different populations. Knowledge of such variation may be important for performing lobectomies, surgical resections, and correct interpretation of radiological images.

Morphological variation of human lung fissures and lobes: An anatomical cadaveric study in North Karnataka, India

Introduction Human lungs are normally divided into lobes by complete fissures which facilitate the movements of lobes in relation to one another during respiration. The knowledge of normal and abnormal fissures and lobes is important because it is essential to clinicians & radiologists in making correct diagnosis and treatment of lung diseases. Lack of knowledge misleads a doctor in proper localization of pathological lesions & their spread; interpretation of lung diseases in X-ray & CT Scan and in planning surgical approach during thoracoscopic lung resection. Keeping the above facts in mind the present study was aimed to look into the incidence of morphological variations of lung anatomy in North Indian population of western U.P. region. Method The present study was conducted on 50 pair of lungs obtained from the cadavers available in the department of Anatomy of Santosh Medical College, Ghaziabad, Uttar Pradesh. The lungs were assessed for any gross deformity and examined for analysis of fissures and lobes. Result The study on Right Lungs revealed the absence of oblique fissure in 8% and absence of Horizontal fissure in 40% of cases. The incidence of incomplete oblique fissure was 24% and that of incomplete Horizontal fissure was 32%. In 20% of the lungs there was complete absence of horizontal and oblique fissures. None of the right lungs showed any accessory fissure. A variation in fissural pattern accordingly caused variation in lobar patterns. A study on Left lung revealed incomplete oblique fissure in 40% and presence of accessory fissures in 24% of cases. The complete absence of oblique fissure on left side was not seen. Discussion Considering the clinical importance of normal and anomalous pattern of fissures and lobes of lungs, it becomes obligatory for us to have a fair knowledge of this subject so that no mistake is committed in diagnosing and treating a patient with lung pathology.

Anomalous fissures and lobes of human lungs of North Indian population of western U.P.

Pancreatic glandular tissue situated outside the normal anatomical site of the human body is called heterotopic pancreas. The incidence is very low as mostly it remains asymptomatic. It is usually found in association with stomach and duodenum, but it may be found in relation with any organ and even outside the abdominal cavity. When symptomatic, it may present as pain in the abdomen, pancreatitis, gastrointestinal tract bleed, abscesses, cysts, or malignancy of the concerned organ. Gastric ectopic pancreas is diagnosed by ultrasonic endoscopy and tissue biopsy. Conservative treatment gives a temporary relief. Local wedge resection of this non-malignant lesion is the ultimate treatment of choice. In the present study, we report cases of ectopic gastric antral pancreas in two young males aging 20 and 16 years who happened to be cousins. They presented with vague symptoms of epigastric pain, nausea, vomiting, etc. One of the patients had h/o melena. The diagnosis was made by endoscopic ultrasonography and confi rmed by endoscopic biopsy. This study further supports the genetic theory of ectopic pancreas as there could be a common type of abnormal genetic signaling pathway leading to trans-commitment of non-pancreatic tissue progenitors to pancreatic lineage in both patients leading to a common type of ectopic pancreatic pathology.

/pdf/heterotopic-pancreas-in-gastric-antrum-a-report-of-two-cases-160vv96t6b.pdf

Heterotopic Pancreas in Gastric Antrum: A Report of Two Cases

The incidence of gallbladder stone disease (Cholelithiasis) is rising high in our country due to changes in life style and food habits. Its prevalence is more in females as compared to males. Besides various well established causes of cholelithiasis, some important anatomical/genetic factors playing a pivotal role in the stone formation are: 1. Crypts or sinuses in the mucosal folds of gallbladder called crypts of luschka. 2. LiTh1 and LiTh2 genes concerned with cholesterol metabolism, and polymorphism of apo-lipoprotein B gene. These above mentioned factors need to be considered as important etiopathogenic basis in the gallstone formation especially in high risk patients. An extra mural compression of CBD by a giant gall stone with clinical features simulating as choledocolithiasis (An example of exception of Courvoisier’s law) should also be kept in mind while planning the line of treatment.

/pdf/a-rare-case-of-giant-gall-stone-in-a-young-prepubertal-5d4nro57sx.pdf

A rare case of giant gall stone in a young prepubertal female

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Anomalous fissures and lobes of human lungs of North Indian population of western U.P.

Heterotopic Pancreas in Gastric Antrum: A Report of Two Cases

A rare case of giant gall stone in a young prepubertal female