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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA BANGALORE ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION 1. Name of the Candidate and Address (in block letters) 2. Name of the Institution Dr. MUTYALAPATI VENKATA RAMULU H. NO. 43, ADARSHA NAGAR, BEHIND JANATA QUARTERS, NEAR K.E.B. OFFICE, KUSUGAL ROAD, KESHWAPUR, HUBLI - 580025 KARNATAKA. J.J.M. MEDICAL COLLEGE, DAVANGERE - 577 004. 3. Course of study and subject POST GRADUATE DEGREE M.D. – ANATOMY 4. Date of Admission to course 23rd MAY 2009 5. Title of the Topic “A STUDY ON THE INCIDENCE OF VARIATIONS IN THE ORIGIN AND COURSE OF RENAL AND ACCESSORY RENAL ARTERIES BY DISSECTION METHOD” 6. Brief Resume of the intended work : 6.1 Need for the study : Renal arteries are a pair of lateral branches from abdominal aorta, at the level of L1-L2 intervertebral disc, supplying right and left kidneys situated on either side of vertebral column. As the variations of renal arteries is common. A sound knowledge of these variations is of utmost importance not only to anatomists, but also to surgeons, radiologists and nephrologists. Thorough knowledge of renal arterial variations helps in interventional radiological techniques like renal angiography. 1 In treating cases of hydronephrosis, where the cause of obstruction might be an aberrant renal artery over the ureter. Complications of nephrectomy like secondary haemorrhage and death, due to unligated upper or lower pole renal artery may be avoided if variations are well known to the operating surgeon. In arriving at a cause for varicocele, which may be due to obstruction of testicular venous outflow by an aberrant renal artery. Hence there is a need for study of variations of renal arteries. 6.2 Review of literature : The paired renal arteries, one each to right and left kidneys branch laterally from abdominal aorta at the level of L1-L2 intervertebral disc, just below the origin of superior mesenteric artery. The right renal artery is longer and often higher than left, passing posterior to the inferior vena cava, right renal vein, head of the pancreas and descending part of duodenum. Left renal artery is a little lower and passes behind the left renal vein, body of pancreas and splenic vein.1 A study conducted on 855 consecutive patients who underwent renal angiography showed, a single renal artery was present in both kidneys in 76%, and multiple arteries in 24%, bilateral multiple arteries in 5%, and early division in 8% of the cases. Additional renal arteries on right side 16% and on left side 13% of all cases. Aberrant renal arteries were 51% and accessory renal arteries 49%.2 A case of multiple variations of right renal vessels was reported, where in 65 years old male cadaver had presence of three right renal arteries. Origin of right inferior suprarenal artery from middle renal artery. Origin of right 2 testicular artery from inferior right renal artery.3 A case of two accessory renal arteries originating from left anterolateral aspect of the abdominal aorta and running into the left kidney, superior and inferior accessory renal arteries run into superior and inferior pole of left kidney respectively.4 In a study conducted on 153 living kidney donors who underwent pre-operative computerized tomography and nephrectomy, showed, the prevalence of multiple renal arteries as 31%.5 In a study conducted on 400 renal pedicles in 200 dissecting – room cadavers. Aberrant inferior polar renal artery was found in 3.5% cases (i.e., 7 cases). Six on right side and one on left side. The vessel originated from the aorta below the level of corresponding renal vein and proceeded upward and laterally behind the vein. At the upper border of vein the artery curved down and descended in front of the vein to reach the kidney near its lower pole.6 6.3 Objectives of the study : To study the variations in the origin and course of right and left renal arteries in human cadavers by dissection method. To record any accessory renal arteries if found. 3 7. Material and Methods : 7.1 Source of data : From embalmed cadavers from the Department of Anatomy, J.J.M. Medical College, Davangere. 7.2. Method of collection of data (including sampling procedure if any): By dissection method Sample size – 50 7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly. No 7.4. Has ethical clearance been obtained from your institution in case of 7.3? Obtained 4 8. References : 1. Susan Standring Ed. Gray’s anatomy. The anatomical basis of clinical practice. 40th Ed. London: Elsevier Churchill Livingstone; 2008 .p.1231. 2. Ugur Ozkan, Levent Oguzkurt, Fahri Tercan, Osman Kizilkilic, Zafer Koc, Nihal Koca. Renal artery origin and variations: angiographic evaluation of 855 consecutive patients. Diag Interv Radiology 2006; 12:183-186. 3. Nayak BS. Multiple variations of the right renal vessels. Singapore Med J 2008; 49(6):e153-e155. 4. Necdet Kocabiyik, Bulent Yalcin, Cenk Kilic, Yalcin Kirici, Hasan Ozan. Accessory renal arteries and an anomalous testicular artery of high origin. Gulhane Medical Journal 2005; 47:141-143. 5. Jee Won Chai, Whal Lee, Yong Hu Yin, Hwan Jun Jae, Jin Wook Chung, Hyeon Hoe Kim, Jae Hyung Park. CT angiography for living kidney donors: Accuracy, cause of misinterpretation and prevalence of variation. Korean J Radiol 2008; 9:333-339. 6. Hilel Nathan. Observation on aberrant renal arteries curving around and compressing the renal vein: Possible relationship to orthostatic proteinuria and to orthostatic hypertension. Circulation. Journal of the American heart association 1958; 18: 1131-1134. 5 9. Signature of the candidate 10 Remarks of the guide 11 Name & Designation of (in block letters) 11.1 Guide Useful for Nephrologists, can be registered. Dr. B. NANJUNDAPPA M.S., PROFESSOR, DEPARTMENT OF ANATOMY, J.J.M. MEDICAL COLLEGE, DAVANGERE - 577 004. 11.2 Signature 11.3 Co-Guide (if any) -- 11.4 Signature -- 11.5 Head of the Department Dr. C.M. RAMESH M.S., PROFESSOR AND H.O.D., DEPARTMENT OF ANATOMY, J.J.M. MEDICAL COLLEGE, DAVANGERE - 577 004. 11.6 Signature 12 Remarks of the Chairman & Principal 12.2. Signature. 6