Download 6.1. Introduction and need for the study

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA,
BANGALORE.
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
DR. SAVITA KUMARI D/O RAMADHAR SINGH
NAME OF THE CANDIDATE
AND ADDRESS
AT- BARKI DELHA, POONSAHAW GALI
POST: GAYA R S, DISTRICT: GAYA
BIHAR-823002
DR. SAVITA KUMARI
(POST GRADUATE STUDENT)
1.
DEPARTMENT OF ANATOMY,
MANDYA INSTITUTE OF MEDICAL
ADDRESS FOR
CORRESPONDANCE
SCIENCES, MANDYA-571 401
KARNATAKA.
E-MAIL: [email protected]
MOB: 9740621049
2.
NAME OF THE
MANDYA INSTITUTE OF MEDICAL
INSTITUTION
SCIENCES, MANDYA-571401
COURSE OF THE STUDY
3.
4.
AND SUBJECT
M.D. (ANATOMY)
DATE OF ADMISSION TO
THE COURSE
19-06-2012
“A STUDY OF BRANCHING PATTERN OF
5.
TITLE OF THE TOPIC
INTERNAL ILIAC ARTERY IN HUMAN
CADAVERS”
6.
Brief resume of intended work.
6.1. Introduction and need for the study:
The internal iliac artery is the “artery of the pelvis”. Internal iliac artery is 4cm long
begins at common iliac bifurcation at the level of lumbosacral intervertebal disc and
anterior to the sacroiliac joint. It descends posteriorly to the superior margin of the
greater sciatic foramen where it divides into an anterior trunk, which continues in the
same line towards the ischial spine, and posterior trunk, which passes back to the greater
sciatic foramen. Anterior to the artery is the ureter and, in females, the ovary and
fimbriated end of the uterine tube. The internal iliac vein, lumbosacral trunk and
sacroiliac joint are located posteriorly. Lateral boundary is formed by the external iliac
vein seen between the artery and psoas major, and inferiorly to this is the obturater nerve.
The parietal peritoneum is medial, separating it from the terminal ileum on the right and
the sigmoid colon on the left .Tributaries of the internal iliac vein are also medial1.
The anterior trunk branches of interal iliac artery are superior vesicle artery,
inferior vesicle artery, middle rectal artery, obturator artery, vaginal artery, uterine artery,
internal pudendal and inferior gluteal arteries. The branches of the posterior division are
iliolumbar, lateral sacral and superior gluteal.
Anterior& posterior divisions supply
pelvic viscera, perineum, pelvic wall, gluteal region. Origin of terminal branches are
subject to variation2.
Variations in the branching pattern of internal iliac artery have long received
attention of anatomists and surgeons. Knowledge of the anatomical variation is beneficial
for the vascular surgeon & gynecologist for ligating the internal iliac artery or its
branches during the pelvic surgery and also for the radiologists to perform and interpret
angiograms of pelvic region. Hence the present study is being undertaken to present the
anatomical knowledge (normal & variations) of internal iliac artery.
6.2. Review of literature:
Internal iliac artery may be longer or shorter than usual its length varying from
2.5 cm to 7.5 cm. But it may be as short as 1.2 cm length of variation dependes on length
of the common iliac; when they bifurcate higher than usual, the internal iliac is longer
and may lie initially above the brim of the true pelvis. The length may also depend upon
the internal iliac itself dividing higher or lower than usual into its branches. This division
may occur anywhere between the brim of the pelvis and the upper border of the
sacrociatic foramen. In some cases the branches arises without the artery dividing into an
anterior and a posterior division or one more branches arise above the division. The
internal iliac may give rise to the following: superior mesenteric vesicoprostatic prostatic,
a common trunk for a superior vesical and a profunda penis, an independent arteria penis
supplying the profunda penis arteries when the dorsal penis artery is a branch of the
internal pundendal, and/or an inferior epigastric artery. Branches of the anterior and
posterior divisions of the internal iliac may exchange origins3.
Adachi classification
Type I -The superior gluteal artery arises separately from the Internal iliac artery, the
inferior gluteal and internal pudendal vessels are given off by a common trunk.
Type II - The superior and inferior gluteal arteries arise by a common trunk and internal
pudendal vessel separately.
Type III - The three branches arise separately from the internal iliac artery.
Type IV - The three arteries arise by a common trunk. The subtyping in this group is
based on the sites of origin of the superior gluteal and the internal pudendal arteries from
the parent stem.
TypeV - The internal pudendal and the superior gluteal arteries arise from a common
trunk and the inferior gluteal has a separate origin.
In 1952 J. L Braithwaite studied on 169 specimen (108 male&61female)
cadavers. Type I arrangement on Adachi's scale in 58% of cases, types III pattern being
found in 22.5%, type II in 15.3%, type IV is least frequent 3.6%. Similar origin of vessels
is noted on both sides in 52.7%. Obturater artery is more variable course4.
In 1998, Yamaki conducted study on 645 pelvic halves of Japanese cadavers. The
branching of the internal iliac artery was classified according to Adachi's classification
(1928). Type I was predominant in accordance of with previous studies. During the
course of this study, some branching forms were different from the types in Adachi's
classification. Therefore, this classification was modified into 5 types and 19 groups.
Type I-Group 1 was most frequently observed in the modified Adachi's classification;
however, the frequency was less than 50% (46.8%). To clarify the basic branching
pattern of the original internal iliac artery and to simplify the classification for medical
purposes, a new classification system was designed. The superior gluteal, inferior gluteal
and internal pudendal arteries were defined as the major branches of the internal iliac
artery, and the umbilical artery excluded from this group. The branching of the internal
iliac artery was classified into 4 groups. Almost 80% of the present specimens were
included in Group A of the new classification , namely, the internal iliac artery dividing
into two major branches, the superior gluteal artery and the common trunk of the inferior
gluteal and internal pudendal arteries. This type of branching seemed to be the basic
branching pattern for the original internal iliac artery5.
In 2010, Tiago Bilhim studied imaging finding of the main branching patterns of
the male internal iliac arteries, using different imaging modalities (angio MR, angio CT
and digital angiography). Twentyone males (mean age 73.2 years) underwent imaging
evaluation with MR angiography,CT angiography and digital substraction angiography to
define the internal iliac artery anatomy before selective embolization of the pelvic
arteries. Internal iliac arterie were classifed into four groups using the Yamaki
classifcation(modifed from the Adachi’s classifcation). Twenty-six pelvic sides were
classifed as Group A(61.9%), 13 as Group B (31%) and 3 as Group C (7.1%) with no
cases of Group D found. Group A was the most frequent internal iliac artery branching
pattern6.
In 2010 Dr. Shivakumar AH studied on 40 adult cadaver pelvis. Type 1 is
predominant in this study 89%, type II is 11%. Total absence of typeIII & typeIV of
adachi classification. Average length was 2 cms to 6.2c.m. Origin of artery was variable
in about 10 cases (34%).7
In 2011 Naveen studied on 60 human bisected pelvises irrespective of their side
and sex. The branching patterns were studied and demonstrated as per the guidelines of
Adachi. The origin of internal iliac artery was at the level of S1 vertebra in majority
(58.3%) of the cases. The average length of internal iliac artery was 37 ± 4.62 mm (range,
13-54 mm). The type I pattern of the internal iliac artery was most common (83.5%)
followed by types III and II. The type IV and V pattern of adachi were not observed8.
In 2012 Ramakrishnan PK studied origin of the three large parietal branches of
the internal iliac atery and were investigated in 50 cadaver specimens (40 male and 10
female). The origins of the major parietal branches conformed to a Type I arrangement
on the Adachi scale in 60 % of cases, a Type III pattern being found in 30 % and a type II
pattern in 8 %. Type IV is less frequent and occurs in 2 % of specimens. In 33.3 % of
instances, a similar origin of branches is noted on both sides9.
6. 3. Objective of the study:
1. To describe the branching pattern of internal iliac artery by dissection method.
2. To describe the origins and course variations in the pattern of branches of internal
iliac artery.
7. Materials and Methods:
7.1. Source of data: The present study will be carried on 50 bisected pelvises from
embalmed cadavers of both gender from Department of Anatomy, Mandya Institute of
Medical Sciences, Mandya.
Study design: Descriptive study.
Study area: Department of Anatomy Mandya Institute of Medical Sciences, Mandya.
Sample size: 50 bisected Pelvises.
7.2. Method of collection of data: Formalin-fixed pelvis specimens will be dissected.
Finer dissection of internal iliac artery and its branches will be carried out. The
observation will be recoded and photographed.
Inclusion Criteria: Pelvis from cadavers, irrespective of age, sex will be included in this
study.
Exclusion Criteria: Pelvis with degenerative or pathological deformities or injuries will
be excluded from this study.
Statistical Analysis: The collected data will be entered in excel sheet and analysed using
Epi-info/SPSS software and the descriptive statistics, ‘chi-square’ test, t’ test and other
applicable statistical tests will be applied for analysing the data as applicable.
.
7.3. Does the study require any investigations or interventions to be conducted on
patients or other humans or animals?
NO
7.4. Has ethical clearance been obtained from your institution?
Yes
-
Submitted
8. List of references.
1. Standring S. Gray’s Anatomy the anatomical basis of clinical practice. 40th ed. New
York: Elsevier Churchill Livingstone; 2008.p.1086-87.
2. Snell RS. Clinical anatomy by regions . 8th ed. Philadelphia: Lippincott, William &
Wilkins; 2008. p. 328-29.
3. Bergman RA, Thompson SA, Afifi AK and Saaden FA. Compendium of human
anatomic variation. Baltimore- Monich: Urban and Schwarzenberg; 1988.p.84-85.
4. Braithwaite JL. Variations in origin of the parietal branches of the internal iliac
artery. J Anat .1952;86:423-430.
5. Yamaki K, Saga T, Doi Y, Aida K, Yoshizuka M. A statistical study of the branching
of the human internal iliac artery. Kurume Med J. 1998;45:333-340.
6. .Tiago Bilhim ,Diogo casal,Andrea Furtado,Diogo Pais,Joao Erse Goyri O’Neill,Joya
Martins Pisco. Branching patterns of the male internal iliac artery imaging findings
Anatomic bases of medical, radiological and surgical techniques .2010.
7. Shivakumar AH, Raju GM, Sathymurthy B, Vijayanath V. Internal iliac artery& its
variation. Anatomica Karnataka. 2010; 4(1): 10.
8. Naveen NS, Murlimanju BV, Kumar V, Jayanthi KS, Rao K, Pulakunta T.
Morphological Analysis of the Human Internal Iliac Artery in South Indian
Population. Online J Health Allied Scs. 2011; 10(1): 11.
9. Ramakrishnan PK, Elezy MA. Variations in the branching pattern of internal iliac
artery. Anatomica Karnataka. 2012; 6 (1): 12.
9
SIGNATURE OF THE CANDIDATE
THE STUDY IS BEING CARRIED OUT
FOR
UNDERSTANDING
CLINICAL
RELEVANCE
THE
OF
THE
ARTERIAL SUPPLY TO STRUCTURES
OF
PELVIS
AND
PROVIDE
SUPPORTIVE EVIDENCE FOR THE
EXISTING DATA AND REPORT THE
10
REMARKS OF THE GUIDE
NEWER FINDINGS FOR THE BENEFIT
OF
SURGEONS
GYNAECOLOGIST
AND
DURING
SURGERIES IN PELVIC REGION AND
RADIOLOGISTS
PERFORMING
ARTERIAL DIAGNOSTIC STUDY AND
THERAPEUTIC
INTERVENTIONS
USING INTERNAL ILIAC ARTERY.
11
NAME AND DESIGNATION OF:
DR. M.S. TRINESH GOWDA
PROFESSOR & HOD,
11.1 GUIDE
DEPARTMENT OF ANATOMY,
MANDYA INSTITUTE OF MEDICAL
SCIENCES, MANDYA-571401.
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
DR. M.S. TRINESH GOWDA
11.5 HEAD OF THE DEPARTMENT
PROFESSOR & HOD,
DEPARTMENT OF ANATOMY,
MANDYA INSTITUTE OF MEDICAL
SCIENCES, MANDYA-571401.
MOB: 9901253179
EMAIL: [email protected]
11.6 SIGNATURE
12
12.1
REMARKS OF DEAN AND
PRINCIPAL
DR. DR. B. DEVANAD
DIRECTOR,
MANDYA INSTITUTE OF MEDICAL
SCIENCES, MANDYA-571 401.
12.2 SIGNATURE
Date: 05. 11. 2012
Mandya
From
Dr. Savita Kumari
Post Graduate Student
Department of Anatomy
MIMS, Mandya
To
The Director / Chairman,
Institutional Scientific Committee,
MIMS, Mandya.
Through: Professor & HOD of Anatomy, MIMS, Mandya.
Respected Sir,
Sub: Submission of synopsis of my research study entitled “A STUDY OF
BRANCHING PATTERN OF INTERNAL ILIAC ARTERY IN HUMAN CADAVERS”. -
Reg.
--With reference to the above subject, I am herewith submitting the copy of
synopsis of my research study entitled “A STUDY OF BRANCHING PATTERN OF
INTERNAL ILIAC ARTERY IN HUMAN CADAVERS”. (4 Copy enclosed) for your
kind perusal and needful action (to be forwarded to RGUHS). Kindly oblige and do
the needful.
Thanking you,
Yours faithfully,
(DR. SAVITA KUMARI)
Post Graduate Student (2012 batch),
Department of Anatomy
MIMS, Mandya
Date: 2. 11. 2012
Mandya
From
Dr. Savita Kumari
Post Graduate Student
Department of Anatomy
MIMS, Mandya
To
The Chairman,
Institutional Ethical clearance Committee,
MIMS, Mandya.
Through: Professor & HOD of Anatomy, MIMS, Mandya.
Respected Sir,
Sub: Submission of synopsis of my research study entitled “STUDY OF INTERNAL
ILIAC ARTERY COURSE AND ITS BRANCHING PATTERN IN HUMAN CADAVER”.
For ethical clearance -Reg.
--With reference to the above subject, I am herewith submitting the copy of
synopsis of my research study entitled “STUDY OF INTERNAL ILIAC ARTERY
COURSE AND ITS BRANCHING PATTERN IN HUMAN CADAVER” (Copy enclosed)
for ethical clearance. This is for your kind perusal and needful action. Kindly oblige
and do the needful.
Thanking you,
Yours faithfully,
(DR. SAVITA KUMARI)
1 year Post Graduate Student
(2012 batch),
Department of Anatomy
MIMS, Mandya
st