The latissimus dorsi is the larger, flat, dorso-lateral muscle on the trunk, posterior to the arm, and partly covered by the trapezius on its median dorsal region. Origin of the latissimus dorsi is from spinous processes of thoracic T7-T12, thoracolumbar fascia, iliac crest and inferior 3 or 4 ribs, inferior angle of scapula and insertion on floor of intertubercular groove of the humerus. We have studied 50 cadavers in the different medical colleges in which we found 2% case of anterior and posterior slip of the muscle fibers with their extension up to the pectoralis major and teres major respectively. Usually, latissimus dorsi involve in extension, adduction, transverse extension also known as horizontal abduction, flexion from an extended position, and internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine. The latissimus dorsi may be used for the tendon graft surgeries. Tight latissimus dorsi has been shown to be one cause of chronic shoulder pain and chronic back pain. Because the latissimus dorsi connects the spine to the humerus, tightness in this muscle can manifest as either sub-optimal glenohumeral joint function (which leads to chronic shoulder pain) or tendinitis in the tendinous fasciae connecting the latissimus dorsi to the thoracic and lumbar spine. Latissimus dorsi used for pedicle transplant rotator cuff repair reconstruction of breast, face, scalp and cranium defect. The extra slip of the latissimus dorsi may puzzle any transplant operations. We as anatomist discuss the clinical implication of the extra slip of latissimus dorsi.
The aim of this study was to analyze anatomy of the celiac trunk through its diameter, length, and variation of its branches. We studied 40 cadavers (25 males and 15 females) in the various colleges in the west India for the variation in the celiac trunk. Dissection of the celiac trunk was performed after opening of the peritoneal cavity. The length of the celiac trunk up to the common hepatic artery was observed. Diameter of the celiac trunk and distance between the celiac trunk and the superior mesenteric artery were observed. We found cases of rare vascular variation in the branching pattern and the common hepatic artery, which arises from the superior mesenteric artery and there is abnormal relation between the common hepatic artery portal vein and the bile duct. In a case we have observed that the superior mesenteric artery gives acute angulations downward on the right side. This type of study of celiac trunk and presence of variation in hepatic arteries will allow the surgeon to practice safe laparoscopic cholecystectomy, liver resections, or vascular recombination in transplantation and, thereby, avoid errors and patient morbidity.
A 10-year-old girl presented with a history of having loose stools and generalised swelling for a 1-month period. She had complex congenital cyanotic heart disease-double outlet right ventricle with anatomy unsuitable for two-ventricle repair. She had undergone Fontan surgery 3 years previously. Fontan completion was staged after pulmonary artery (PA) banding and bidirectional Glenn surgery. Her laboratory parameters showed hypoproteinemia with hypocalcaemia (serum protein 3.4 gm/dL, serum albumin 1.3 gm/dL, serum calcium 5.6 mg/dL). The patient's clinical condition was highly suggestive of a particular syndrome and she was started on treatment for that condition. Her echocardiogram showed significant haemodynamic findings (figure 1). She was referred for cardiac catheterisation and a percutaneous intervention was performed ( figure 2A, B). Following the intervention, she improved dramatically with subsidence of symptoms and signs within 3 days. QUESTIONWhat is the significant unexpected haemodynamic finding identified in this patient's echocardiographic image (figure 1 Image challenge ANSWER This girl is suffering from protein losing enteropathy (PLE) due to a failing Fontan circuit. This four chamber echocardiographic view with anterior tilt shows antegrade flow through the PA which had previously been banded. Such flow is detrimental in Fontan physiology and can have serious haemodynamic consequences.1 2 Antegrade flow may increase PA pressures and lead to increased resistance in the Fontan circulation, which in turn may increase resistance in the mesenteric circulation. This may contribute to the development of PLE. On cardiac catheterisation the patient had a high mean PA pressure (17 mm Hg). Therefore, option 3 is the correct answer.The patient underwent device (Amplatzer duct occluder) closure of the RVOT through a Glenn shunt ( figure 2A, B). Understanding the pathophysiology may be useful in the management of PLE in Fontan physiology (figure 3). 3A large VSD is part of the primary condition, and the ASD, if flowing right to left, may simply reflect the elevated pressure in the system (so options 1 and 2 are not correct). There is no left ventricular outflow obstruction (so option 4 is not correct).
In a post operative tetralogy of fallot (TOF) physiology patient, abnormal right ventricular (RV) function remains the greatest matter of concern. Due to restrictive RV diastolic dysfunction, there is detectable antegrade diastolic flow in the pulmonary artery during atrial systole. We report a case of 21 year old male patient with total correction done in infancy using right ventricle to pulmonary artery conduit. He was relatively asymptomatic with a unique pattern of antegrade diastolic flow in both early and late diastolic phases (pan diastolic). This physiology was supportive and made him relatively asymptomatic. We discuss the physiology and clinical implication of the same.
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