RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. NAME AND ADDRESS OF
THE CANDIDATE / Dr. SIRAJ AHMED SHIRABADGI
DEPARTMENT OF ANATOMY
JSS MEDICAL COLLEGE
MYSORE-570015
KARNNATAKA
2. NAME OF THE INSTITUTION / JSS MEDICAL COLLEGE
SS NAGAR MYSORE-570015
3. COURSE OF STUDY AND
SUBJECT /
M.D (ANATOMY)
4. DATE OF ADMISSION TO
THE COURSE /
31-05-2007
5. TITLE OF THE TOPIC / STUDY OF ARTERIAL SUPPLY OF HUMAN SUPRA RENAL GLANDS
AND ITS VARIATIONS

6. BRIEF RESUME OF THE INTENDED WORK

6.1  NEED FOR THE STUDY

The suprarenal glands are paired endocrine glands. They are situated in relation with the superior poles of the kidney, these glands are highly vascular, supplied by three arteries and drained by one vein, the three arteries are named as superior, middle and inferior suprarenal arteries. Normally superior suprarenal artery arises from inferior phrenic artery, middle is a direct branch of abdominal aorta and inferior from renal artery. Variation in the origin of supra renal arteries and branching pattern have been described. In the present work the variation in the origin and branching pattern of these arteries will be studied on both the sides.

This knowledge of variation is indispensable for surgeons undertaking adrenalectomy (open or laproscopic) in benign conditions such as Cushing’s syndrome, adrenal mass etc and in malignant conditions like pheochromocytoma, carcinoma, sarcoma etc. Knowledge of variation is extremely important for surgeons performing nephrectomy (open or laproscopic) in malignancy of kidney. It is also helpful for kidney transplant surgeons. .

Hence the present work is undertaken to study the variation in the origin and branching pattern of suprarenal arteries.

6.2. REVIEW OF LITERATURE

The suprarenal (Adrenal) glands are very vascular, each gland supplied by three arteries. Superior suprarenal artery; arise from inferior phrenic artery, which is a branch of abdominal aorta, it is often small and may be absent. Middle suprarenal artery; arises from abdominal aorta. Inferior suprarenal artery; arise from the renal arteries, usually from main artery but occasionally from its upper pole branches.1

The arteries to the suprarenal gland are typically at least three sources, and most textbooks list only three arteries, but this gives entirely false impression of the arterial supply to the gland.2

The adrenal and thyroid gland are the viscera having the greatest blood supply per gram tissue. Superior suprarenal artery; a group of six to eight, arises separately from inferior phrenic artery. Middle suprarenal artery; arise from aorta, it can be single multiple or absent. Inferior suprarenal artery; arise from renal artery, may arise from accessory renal artery, superior polar artery, small twig may arise from the upper ureteric artery.(Eustachis 1522 discovered adrenals and in 1563 reported his findings)

Frey in 1875 noted the presence of rich blood supply in adrenals.3

Other vessels originating from the intercostals and gonadal vessels may also supply the adrenals.4

The suprarenal arteries from aorta is more variable.5

Dissection of 30 cadavers, only the superior and inferior appear in all cases, middle only 93.3%~4.6 of cadavers.6

Variation of inferior suprarenal arteries most often from the trunk of renal artery prior to its terminal division, other possible origin were terminal branches (most often from anterior division, rarely posterior one).7

Arteries that show frequent variation include superior, middle & inferior suprarenal arteries.8

High origin and unusual branch of testicular artery. In a 42 years male cadaver testicular artery gave off a branch which supply left suprarenal gland.9

6.5. OBJECTIVES OF THE STUDY

To study the normal pattern and any variations in origin, course, branching and termination of suprarenal arteries.

To know the difference in pattern of suprarenal arteries in either sexes and variation in right and left side.

The present study helps the surgeons and interventional radiologist to diagnose and plan the line of treatment.

7. MATERIALS AND METHOD

7.1 SOURCE OF DATA

Specimen of human suprarenal glands will be studied a) Specimen will be collected from the cadavers dissected by students of Anatomy

JSS Medical College Mysore. b) Will be obtained from the department of Forensic Medicine, JSS Medical College

Mysore

7.2 METHOD OF COLLECTION OF DATA

a) Arterial supply of supra renal gland will be studied by Dissection method

b) Univariate analysis and cross tabulation will be presented to study the variations in origin, course, branching and termination of the arteries and their comparison with normal pattern as stated in the literature. Chi-square test will applied at 5% level of significance to asses the difference in pattern by sex and side of the glands. The study will include the specimens collected during NOV2007 to JUN 2009. Number of specimens 50.

.

7.3 Does your study require any investigation or intervention to be conducted on patients or other humans or animals? If so please describe briefly.

No, the study does not require any investigations or interventions.

7.4 Has ethical clearance been obtained from your institution?

YES (Certificate enclosed)

8. LIST OF REFERENCES

1.  GRAY`S ANATOMY. The Anatomical Basis of Clinical Practice. Susan standring, Elsevier Churchil Livingstone.2005: 39th ed:1245-1249pp

2.  Hollingshed WH, Ross C, editors. Text book of human Anatomy. 4th ed.Philadelphia:Harper and Row, 1985:577pp

3.  SKANDALAKIS` Surgical Anatomy. The embryologic and anatomic basis of modern surgery.2004, vol 2,1st ed:1541-1565pp

4.  Mastery of surgery Lloydsm, Nyhus Robat T, Benker.1992, 2nd ed, vol2:1373-1374pp

5.  Anatomical record arterial supply of suprarenal gland vol, 144,4:359-371pp

Rober J Merklin,Danial baugh institute of anatomy, Jefferson Medical College,

Philadelphi182(5)483-8pp a Pennsylvania

6.  Variation of supra renal arteries. Manso JC, Didio LJ. Ann Anat 2000 sep

182(5)483-8pp

7.  Nayak SR, J JP, D’Costa et al. Rom j morphol embroil 2007,48(2)155-59pp

8.  Deepthinath R,Sateesha et al. Multiple variation of paired arteries of the abdominal aorta. Clinical Anat 2006 Sep 19(6)566-8pp

9.  High origin and unusual branch of testicular artery. Brochi RA, Sargon MF, Yener N. Surgi Radiol Anat 2001,June 23(3);207-8pp

9. Signature of the candidate
10.Remarks of the guide / Present study throws light on variation in blood supply of the suprarenal glands, helpful for surgeons and radiologists.
11.Name and designation of
11.1.Guide / Dr.C.M.Nanjaiah, MBBS, MS.
Professor, Department of Anatomy
JSS Medical College-mysore 570015
11.2.Signature
11.3.Co-Guide
11.5.Signature
11.5.Head of the Department / Dr.N.M.Shamasundar.BSc,MBBS,MS,MISP.
Professor and HOD
Department of Anatomy,
JSS Medical College, Mysore-570015.
11.6.Signature
12.1.Remarks of the chairman a and The Principal
12.1.Signature