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K S Satyapal

Publications and source records attributed to K S Satyapal.

At least 19 recordsLinked to original sources
PubMed2006

Duplicate gallbladder: an unusual case report.

Duplication of the gallbladder, a rare congenital anomaly, is important in clinical practice as it may cause some clinical, surgical and diagnostic problems. In this report we present a case of duplicated gallbladder diagnosed serendipitously in a 63-year-old male patient who had previously undergone successful laparoscopic cholecystectomy (confirmed histologically) approximately a year before for gallstones. The patient was re-admitted with obstructive jaundice. An abdominal computed tomography scan and magnetic resonance cholangiogram both revealed the presence of a gallbladder, which was thereafter removed at surgery undertaken to palliate the jaundice.

Cholecystectomy↗
PubMed2006

Cervico-thoracic ganglion: its clinical implications.

Lesions of the cervicothoracic ganglion (CTG) result in interruption of sympathetic fibers to the head, neck, upper limb, and thoracic viscera. The accurate understanding of the anatomy of the CTG is relevant to sympathectomy procedures that may be prescribed in cases where conventional intervention has failed. This study documents the incidence and distribution of the CTG to avoid potential complications such as Horner's syndrome and cardiac arrhythmias. This study utilized 48 cadavers, in which a total of 89 sympathetic chains were dissected. The inferior cervical ganglion (ICG) and the first thoracic ganglion was fused in 75 cases (84.3%) to form the CTG. It was present bilaterally in 48 of these specimens (65.3%). Three different shapes of CTG were differentiated, viz. spindle, dumbbell, and an inverted "L" shape. The dumbbell and inverted "L" shapes demonstrated a definite "waist" (i.e., a macroscopically visible union of the ICG and T1 components of the CTG). Rami from the CTG was distributed to the brachial plexus, the subclavian and vertebral arteries, the brachiocephalic trunk, and the cardiac plexus. This study demonstrates a high incidence of a double cardiac sympathetic nerve arising from CTG. It is therefore imperative that in the technique of sympathectomy, for intractable anginal pain, the surgeon excises both these rami but does not destroy the ganglion itself. The ever-improving technology in endoscopic surgery has made investigations into the nuances of the anatomy of the sympathetic chain essential.

Adult↗
PubMed2006

Atypical anastomosis of laryngeal nerves.

The larynx and its associated structures derive their chief source of innervation from the superior and recurrent laryngeal nerves. Surgery of the larynx requires a sound knowledge of the normal anatomy as well as variations that may be encountered in this region. We report the presence of rare communications between the right external and internal laryngeal nerves as well as between the right external and inferior laryngeal nerves via a thyroid foramen. In addition, we report on bilateral innervation of the respective ipsilateral aryepiglottic, transverse, and oblique arytenoid muscles by the internal laryngeal nerve, which is contrary to the classical descriptions of this nerve. The anatomic features are described and clinical implications are highlighted.

Dissection↗
PubMed2005

The surgical anatomy of the parotid fascia.

UNLABELLED: Currently, there are no reports in the literature of the parotid fascia suggesting that this structure is crucial to the identification of the facial nerve trunk (FNT). Traditional surgical and anatomical descriptions of this fascia report it as a collection of connective tissue large enough to be described by the unaided eye. This study was performed to investigate the composition and limit of the fascia surrounding the parotid gland. An appreciation of these on safe and effective parotid surgery was also considered. HISTO-ANATOMICAL STUDY: Microsurgical step-by-step dissection was performed on 18 adult cadavers (n=36) to define the composition, arrangement, and attachment of the parotid fascia. Samples were subjected to the Masson Trichrome Technique (1990). CLINICAL STUDY: A total of 18 patients presented for parotidectomy. Eight patients had a pleomorphic adenoma and ten had lympho-epithelial disease of the parotid gland. Boundaries of parotid fascia were posteriorly-mastoid process, anteriorly--ramus of mandible, superiorly--cartilage of external acoustic meatus, and inferiorly-imaginary line joining tip of mastoid process to ramus of mandible. These landmarks formed a quadrangular space. HISTO-ANATOMICAL STUDY (N=36): Parotid fascia formed a fibrous meshwork over the gland. In the upper two-thirds, fascia was thick and strong; in the lower one-third, fascia was thin. Soft tissue arrangement (from superficial to deep): dermis, subcutaneous fat, superficial cervical fascia, deep cervical fascia. CLINICAL STUDY (N=18): The technique described was applied consistently in all patients. Mean time for localization of FNT was 11 min (range 7-18 min). In two patients (both with an underlying inflammatory disorder of the parotid gland), a transient facial nerve palsy developed postoperatively. In both patients, this settled within 7 weeks of operation. The true surgical potential of the parotid fascia during parotidectomy has been reported.

Adenoma, Pleomorphic↗
PubMed2005

Anatomical variations of the second thoracic ganglion.

In recent years the second thoracic ganglion has gained anatomical significance as an important conduit for sympathetic innervation of the upper extremity. Thoracoscopic excision of the second thoracic ganglion is now widely recognized as affording the most effective treatment option for palmar hyperhidrosis. This study recorded the incidence, location and associated additional neural connections of the second thoracic ganglion. Bilateral dissection of 20 adult cadavers was undertaken, and all neural connections of the second thoracic ganglion were recorded. Nineteen cadavers (95%) demonstrated additional neural connections between the first thoracic ventral ramus and second intercostal nerve. These were classified as either type A (47.5%) or type B (45%) using the intrathoracic ramus (nerve of Kuntz) between the second intercostal nerve and the ventral ramus of the first thoracic nerve as a basis on both right and left sides. The second thoracic ganglion was commonly located (92.5%) in the second intercostal space at the level of the intervertebral disc between the second and third thoracic vertebrae. Fused ganglia between the second thoracic and first thoracic (5%) and stellate (5%) ganglia were noted. These findings should assist the operating surgeon with a clear knowledge of the anatomy of the second thoracic ganglion during thoracoscopic sympathectomy with a view to improving the success rate for upper limb sympathectomy.

Adult↗
PubMed2005

Ethics, transplantation, and the changing role of anatomists.

Anatomists are regarded as custodians of cadaveric material donated to science. Almost every facet of medical science has experienced explosive advances. This has impacted directly on anatomists and their role. Increasingly, anatomists are raising concerns with regard to the treatment of human tissue (Jones,2002, Clin. Anat. 15:436-440). The Korperwelten (Bodyworlds) of Gunther von Hagens et al. (1987, Anat. Embryol. 175:411-421) has evoked considerable debate about the treatment of human cadavers. Thus far clinical anatomists have had little role to play in policy formulation, legislation, and ethical imperatives as applied to cadaveric donation for organ transplantation. Anatomists play an even more negligible role in the raging ethical controversy around live related/unrelated organ transplantation. Due to the critical international shortage of cadaveric donors, boundaries are being pushed to meet the needs of potential recipients (Ohler,2001, Prog. Transplant. 11:160-161). Constant reappraisal of these ethical and moral issues is therefore appropriate. Issues that relate to cultural and economic imperialism and pronouncements of international transplant societies may also require re-evaluation. The legislature governing the donation of human tissue in various countries is usually governed by a Human Tissue Act or its equivalent. In general, such acts are congruent with the Human Tissue Act (South Africa: Government Gazette 9, November 2001; No. 22824) that states "It is an offense to charge a fee in relation to the donation of human organs." In many countries, however, various lay press report that "the sale of body parts is now coming of age." Terms such as "rewarded gifting" and "donors" being transformed into "vendors" are opening a Pandora's Box (Nelson et al.,1993, "Financial incentives for organ donation: a report on the UNOS ethics committee payment subcommittee"). Cameron and Hoffenberg (1999, Kidney Int. 55:724-732) feel strongly that arguments in favour of the sale of organs are sufficiently cogent to warrant further discussion. Equally disturbing is the use of executed prisoners as organ donors. In the developing world there are additional socio-economic, indigenous and cultural, religious, and ethical issues to consider. In addition, strategies that are ethically sound and morally acceptable to expand the pool of living donors must keep pace with recent advances in medicine. A paradigm shift is required for anatomists to contribute to the international ethical debate, not only as custodians of the dead but also as protectors of the living. Their voices should be heard in transplantation and other forums, and contribute to the ethical debate as well as relevant evolving legislature.

Anatomy↗
PubMed2004

The anatomical rationale for an upper limb sympathetic blockade: preliminary report.

Stellate ganglion blockade (SGB) has long been considered pivotal in the diagnosis, determination of prognosis and management of chronic regional pain syndrome (CRPS) by sympathectomy. To date a variety of SGB techniques have been described. An inaccurate SGB may mislead clinicians and deny patients a potentially beneficial procedure. In order to obtain a predictable and readily reproducible blockade of the upper limb, a modified anterior technique was evaluated. This modified sympathetic block was performed in 10 adult cadavers (n=19 sides). Toluidine blue solution (10 ml) was injected and, following median sternotomy, the extent of spread of dye was evaluated. In one cadaver a dual block using both the modified and the standard techniques was performed. Proximal spread to the seventh cervical vertebra was noted in all blocks; distal spread extended to the neck of the third rib (n=3), neck of the fourth rib 7 (n=15) and neck of the seventh rib (n=1). Medial spread was greater than lateral spread and extended to the vertebral bodies (vagus nerve was also stained) while lateral spread in all cases "blocked" lower roots of the brachial plexus and was consistently noted beyond the usual location of the nerve of Kuntz. This modified technique demonstrated that the lower cervical ganglia and proximal thoracic sympathetic trunk were consistently stained. It should be noted that the spread was sufficiently lateral to block the nerve of Kuntz. The pitfalls of this technique aside, we suggest that this technique be reserved for therapeutic purposes, particularly when sympathectomy is not possible.

Adult↗
PubMed2004

Anatomical basis for a successful upper limb sympathectomy in the thoracoscopic era.

In this clinico-anatomical study, factors potentially responsible for unsuccessful upper limb sympathectomy (ULS) by the thoracoscopic route were evaluated. This study comprised two subsets: 1) in the clinical subset, 25 patients (n = 50 sides) underwent bilateral second thoracic ganglionectomy for palmar hyperhidrosis, and factors predisposing to unsuccessful ULS were identified; and 2) in the anatomical subset, the neural connections of the first and second intercostal spaces were bilaterally dissected in 22 adult cadavers (22 right, 21 left; n = 43 sides). Alternate neural pathways (ANP) were noted in 9 of 50 sides in the 25 clinical cases (18%). In three asthenic patients (5 sides), fascia overlying the longus colli muscle mimicked the sympathetic chain. The right superior intercostal vein (SIV) was located anterior to the second thoracic ganglion in 6 of 50 sides (12%) and predisposed to troublesome bleeding in 2 of 50 cases; the SIV was posterior to the ganglion in 19 of 50 sides (38%), posing no technical problem. On the left, the SIV was noted outside the field of dissection in all but one case. A successful outcome to sympathectomy was noted in all 25 patients. A spectrum of sympathetic contributions to the first thoracic ventral ramus for the first intercostal space was noted in 37 of 43 anatomical cases (86%). These were categorized according to the arrangements of the intrathoracic ramus between the second intercostal nerve and the first thoracic ventral ramus. The cervicothoracic ganglion (37/43 cases; 86%) and an independent inferior cervical ganglion (6/43 cases; 14%) were always located above the second rib. The second thoracic ganglion was consistently located in the second intercostal space. This study demonstrates that ANPs have little clinical significance when a second thoracic ganglionectomy is undertaken. Technical failures may be avoided if the surgeon is mindful of anatomical variations at surgery.

Adult↗
PubMed2003

The sympathetic contributions to the cardiac plexus.

Cardiac sympathetic denervation for intractable angina pectoris in patients unsuitable for conventional revascularization is currently gaining popularity since this procedure may be performed via minimally invasive surgery. A thorough understanding of cardiac innervation and its variations is crucial to successfully effect cardiac denervation. This study aimed to demonstrate the cervical and thoracic sympathetic contributions to the cardiac plexus. The cervical and thoracic sympathetic trunks in 21 fetuses and eight adults were micro-dissected bilaterally and documented ( n=58 sides). The superior cervical cardiac ramus originated from the superior cervical ganglion (present in all specimens) in 53% of cases. The middle cervical ganglion (incidence 81%) gave rise to the middle cervical cardiac ramus in 88% of cases. The cervico-thoracic ganglion (incidence 85%) gave the cervico-thoracic cardiac ramus in 84%. In the thoracic region, four cardiac rami arose from the T2-T6 segment of the thoracic sympathetic trunk. All cervical and thoracic cardiac rami were traced consistently to the deep cardiac plexus. Khogali et al.'s (1999) success of limited T2-T4 sympathectomy in relieving pain at rest of patients with intractable angina pectoris appears to indicate that a significant afferent pain pathway from the heart is selectively interrupted. The variability in pattern of the cervical ganglia, cardiac rami and cervical contributions to the cardiac plexus does not appear to affect the outcome of limited sympathectomy. The complexity of cardiac pain pathways is not fully understood. The study is continuing and attempts to contribute to defining these cardiac neuronal pathways.

Adolescent↗
PubMed2003

A thoracoscopic view of the nerve of Kuntz.

The nerve of Kuntz and alternate neural pathways (ANPs) have long been considered crucial for upper limb sympathetic supply. However, at thoracoscopy, these structures are neither consistently identified nor searched for. This is probably reflective of the effectiveness of an isolated second thoracic ganglionectomy for upper limb sympathectomy. We present the case of a 19-year-old male who underwent a second thoracic ganglionectomy for palmar hyperhidrosis. On the left side, approximately 2.5 cm lateral to the typically located sympathetic chain, a filamentous structure (one-quarter the diameter of the sympathetic chain), identified as the nerve of Kuntz, was noted coursing across the neck of the second rib.

Adult↗
PubMed2003

Thoracoscopy: a new era for surgical anatomy.

In this new era of minimal access surgery, advances in optics and illumination have established thoracoscopic sympathectomy as a pre-eminent procedure, including a safe and efficient technique for upper limb sympathectomy. The success of thoracoscopy will doubtless ensure that a greater number of these procedures will be carried out and will put some of the daunting technical challenges posed by traditional open surgical procedures to rest. The thoracoscopic era affords the surgical anatomist a new challenge: to move the teaching of living anatomy to a higher level.

Anatomy↗
PubMed2003

Inferior lumbar triangle hernia: case report.

A patient with a spontaneously acquired hernia along the inferior lumbar triangle commonly referred to as lumbar triangle of Petit is presented. This was confirmed on CT scan and successfully treated surgically. A review of the literature relevant to this condition is presented. It is likely that with advances in imaging techniques and a wider clinical usage of these investigative modalities there will be further recognition of this uncommon condition.

Hernia, Abdominal↗
PubMed2003

Why we use the donor left kidney in live related transplantation.

UNLABELLED: In addition to the superior graft survival afforded by live related transplantation, this option has assumed an important role in the management of endstage renal failure in centres confronted with a scarcity of cadaveric kidneys. In pursuing this option, it is imperative that the donor has minimal morbidity. An ongoing dilemma is which side the kidney should be harvested from. This study reviews the anatomical basis for selecting the left kidney and the impact on outcome for patient and donor. A database comprising cadaveric and clinical subsets was analysed. The total sample size analysed was 1 244 kidney pairs (305 cadaveric; 939 clinical (61 live related left kidney transplants harvested by the extraperitoneal approach)). RESULTS: Additional renal arteries (ARAs): Right first, second = 18.6%, 4.7%; left first, second = 27.6%, 4.4%. Additional renal veins (ARV): Right first, second = 26%, 3.3%; left first only = 2.6%. Length of renal vein (cm): Right 2.4 +/- 0.7, left 5.9 +/- 1.5. Other venous variations encountered were on the left side only (renal collar 0.3%, retro-aortic vein 0.5%). In the live related transplant series 24.6% ARAs were encountered (first 19.7%, second 4.9%). The postoperative course and outcome of both donor and recipient were not associated with increased morbidity. While greater length of the left renal vein (LRV) afforded easier technical manipulation, it is interesting to note that its length is shorter than that reported in the literature. ARVs are infrequent on the left and when encountered the smaller calibre vessel may be ligated with impunity due to rich intrarenal anastomosis. In selecting the donor kidney the surgeon has to balance the prospect of fewer ARAs on the right against the benefit of a longer LRV. The solution to this dilemma can only arise from a randomised clinical study. In our practice, consistent use of the left kidney has not affected clinical outcome.

Cadaver↗
PubMed2001

Right aortic arch with isolated left brachiocephalic artery.

Right aortic arch with complete isolation of the left brachiocephalic artery is an extremely uncommon anomaly of the aortic arch. This case reports the hitherto unreported association of the right aortic arch with isolated left brachiocephalic artery presenting with a subclavian steal syndrome detected in a 36-year-old female patient being investigated for increasing attacks of episodic dizziness, vertigo, and left upper limb claudication spanning 1 year. A review of the literature relevant to this condition is presented. It is likely that with advances in imaging techniques and a wider clinical usage of these investigative modalities there will be further recognition of these uncommon conditions.

Adult↗
PubMed2001

Lithopedion: a case report.

An 80-year-old Black, South African woman presented in the outpatient department with severe abdominal pain. Ultrasound examination revealed a large echogenic mass (20 x 20 cm) in the right upper quadrant. An abdominal x-ray demonstrated the skeleton of a fully developed extrauterine fetus. It is presumed from the patient's history that this fetus was present for at least 40 years. Radiography revealed a fetus shrouded in a mantle of calcification. The fetus was hyper-flexed with other signs of "intrauterine" death. Fetal dentition charts dated the fetus at 34 weeks, the epiphyses being obscured by extensive calcification. In addition to subcutaneous calcification there was extensive visceral and intracranial calcification.

Abdomen, Acute↗
PubMed2001

Additional renal arteries: incidence and morphometry.

Advances in surgical and uro-radiological techniques dictate a reappraisal and definition of renal arterial variations. This retrospective study aimed at establishing the incidence of additional renal arteries. Two subsets were analysed viz.: a) Clinical series--130 renal angiograms performed on renal transplant donors, 32 cadaver kidneys used in renal transplantation b) Cadaveric series--74 en-bloc morphologically normal kidney pairs. The sex and race distribution was: males 140, females 96; African 84, Indian 91, White 43 and "Coloured" 18, respectively. Incidence of first and second additional arteries were respectively, 23.2% (R: 18.6%; L: 27.6%) and 4.5% (R: 4.7%; L: 4.4%). Additional arteries occurred more frequently on the left (L: 32.0%; R: 23.3%). The incidence bilaterally was 10.2% (first additional arteries, only). The sex and race incidence (first and second additional) was: males, 28.0%, 5.1%; females, 16.4%, 3.8% and African 31.1%, 5.4%; Indian 13.5%, 4.5%; White 30.9%, 4.4% and "Coloured" 18.5%, 0%; respectively. Significant differences in the incidence of first additional arteries were noted between sex and race. The morphometry of additional renal arteries were lengths (cm) of first and second additional renal arteries: 4.5 and 3.8 (right), 4.9 and 3.7 (left); diameters: 0.4 and 0.3 (right), 0.3 and 0.3 (left). Detailed morphometry of sex and race were also recorded. No statistically significant differences were noted. Our results of the incidence of additional renal arteries of 27.7% compared favourably to that reported in the literature (weighted mean 28.1%). The study is unique in recording detailed morphometry of these vessels. Careful techniques in the identification of this anatomical variation is important since it impacts on renal transplantation surgery, vascular operations for renal artery stenosis, reno-vascular hypertension, Takayasu's disease, renal trauma and uro-radiological procedures.

Adolescent↗