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Background: Adrenal gland is a lifesaving endocrine gland of the human body. Knowledge of normal microscopic anatomy of the Adrenal gland facilitates Pathologists to correlate and make the differential diagnosis of various adrenal glands associated clinical conditions on histopathological examination. Aims and Objective: To study histological features of human adrenal gland in the post-natal period at different ages. Materials and Methods: Present study is conducted with 98 human adrenal glands from 49 unclaimed dead bodies during an autopsy and 22 human adrenal glands from 11 cadavers during routine dissection in S.V Medical College, Tirupati, which were utilized after obtaining consent from the close kith and kin. During the autopsy/dissection, the samples collected were from 2 Years to 64 years of age individuals of both sex with typical external features and divided into three groups. The first group consisted of less than 25 years of age. The second group consists of ages between 26 years to 50 years. The third group included 51 years and above, and all the specimens are processed for histological staining and observed under the microscope. Results: At 2 years well-developed capsule with large vessels and well-differentiated zones of definitive cortex and medulla were identified. The thick muscular coat of the central vein was identified at 20 years. At 36 years & 45 years, cellular architecture in various zones is very well differentiated. At 65 years, the cortico-medullary demarcation was irregular, and vascularity decreased. Conclusion: Histological features of pre-pubertal, adult, and old age group sections helps in the understanding of post-natal changes in the growth of the Suprarenal gland and its functions.

According to Ayurveda dhatus (structural entities) are circulating through a channel known as srotas, these strotas carry dhatu (tissue elements or their constituent) undergoing transformation to their destination. Each srotas has 2 mulasthan (roots), which are different according to various text of Ayurveda. Different Acharyas describe roots of Medowaha srotas differently upto some extent, with this context the exploration of this concept is needed with respect to modern science which is mostly based on Pratyaksha pramana. An Ayurvedic principle, to treat the diseases of respective srotas, root site has to be treated. About medowaha srotas, out of two roots one is “Vrikka” is common in all text, but the second root is different with this context exploration is needed. When we correlate term Vrikka with kidney, we can’t full fill the aspect of Meda (fat) metabolism but if Vrikka is correlates with kidney plus suprarenal gland then we can. In Structure suprarenal gland are attached to kidneys on superior side kidneys and suprarenal glands are made up of same tissue. The diseases of Meda dhatu given by compendia are correlated with diseases of hormone cortisol secreated by suprarenal gland, and cortisol is responsible for fat metabolism. Even suprarenal glands are not described in any text of Ayuurveda. The second roots given by Acharyas are Vapawahan, kati, Mansa and Jatharmeda respectively all these structures are deposited with adipose tissue having adipocyte. During starvation this tissue is metabolized and used for energy. So, these all structures are roots of Medowaha srotas.

Background: Estimation of post-mortem intervals (PMI) is a critical step in most un-witnessed death investigations. After death, bodies begin to decompose in regular patterns which are used to estimate physiological time of death. These changes occur in widely variable ways and no single factor accurately indicates PMI. Objectives: This work aimed to compare between two different methods in estimation postmortem interval which are histopathological changes in suprarenal gland and vitreous humor potassium level. Materials and methods: The study was conducted on 50 Newzeland male rabbits, at the beginning of the study the rabbits were sacrificed by cervical dislocation then they were classified into 5 groups (I, II, III, IV, V) according to the PMI (0, 6., 12., 18 and 24 hours ) respectively. Histopathological and histometric examination [chromaffin cell count (cell /100 μm2), medullary surface area (μm2) and total chromaffin cell count] for left suprarenal were done. Spectroscopic determination of vitreous humor potassium was done. Results: There was significant statistical increase in the mean value of chromaffin cell count (cell/um2) and the vitreous humor potassium level (mEq/L) with increased PMI (P-value was 0.001). On contrast, there was significant statistical decrease in the mean value of the suprarenal medullary area (μm2) and total chromaffin cell count with increased PMI (P-value was 0.001). The results showed significant positive correlation between the vitreous humor potassium level (mEq/L) and chromaffin cell count (cell/100μm2). On the other hand the findings showed significant negative correlation between the vitreous humor potassium level (mEq/L) and the suprarenal medullary area (μm2) and total chromaffin cell (P value was 0.001). Conclusion: The vitreous humor potassium level in combination with the chromaffin cell count (cell/100μm2), suprarenal medullary area and total chromaffin cell count can give more accurate estimation of the postmortem intervals. Keywords: postmortem interval, suprarenal gland, vitreous humor potassium.

Stress loading simulation was carried out on albino male rats aged 3 months. An analysis of structural changes of the suprarenal gland cortex and the spongy substance of the humeral bones under the action of stress and similar indices of intact animals was performed. The degree of the influence of stress on their structure was determined., Моделирование стрессовой нагрузки проводили на белых крысах-самцах 3-месячного возраста. Проведен анализ изменений структуры коры надпочечных желез и губчатого вещества плечевых костей под действием стресса и аналогичных показателей интактных животных. Установлена степень влияния стресса нa их структуру., Моделювання стресового навантаження проводили на білих щурах-самцях 3-місячного віку. Проведено аналіз змін структури кори надниркових залоз та губчастої речовини плечових кісток під дією стресу та аналогічних показників інтактних тварин. Визначено ступінь впливу стресу на їхню структуру.

Background Becoming acquainted with the variants of the inferior phrenic artery is crucial for surgeries done for compression syndrome of the coeliac trunk. Awareness of the arterial variations of the suprarenal gland is important while performing surgical and radiological interventions of this gland and its surrounding structures. Materials and methods The present report mentions the unilateral variations of the inferior phrenic artery and suprarenal arteries in a middle-aged male cadaver, noticed during the routine dissection done for undergraduate teaching. Main findings It was observed that the right inferior phrenic artery instead of, originating from the lateral aspect of the abdominal aorta arose from, the coeliac trunk as its first branch. The right middle suprarenal artery was absent. The right inferior suprarenal artery arose as four branches, of which two were seen branching from the right renal artery, whereas the other two branched out from the right testicular artery. Interestingly, one branch of the inferior suprarenal artery that arose from the right testicular artery formed a loop around the right renal vein, before supplying the suprarenal gland. Conclusion Prior knowledge of the aforementioned variations may be useful during selective angiography of the suprarenal gland done for the diagnosis of adrenal hyperplasia, small suprarenal adenoma, and suprarenal metastasis from carcinoma lung.

Mixed type of blood supply (72 %) of the suprarenal glands with the participation of three groups of arteries (superior, medialand inferior) is observed in 9-10 month old fetuses, more rarely – aortal (22 %) and renal (6 %) types. The greatest number of suprarenal gland's vessels is peculiar to superior main and inferior additional suprarenal arteries. The correlation between the number of main suprarenal arteries and the shape of the gland was determined., У плодов человека 9-10 месяцев наблюдается смешанная форма кровоснабжения (72 %) надпочечных желез с участием трёх групп артерий (верхних, средних и нижних), реже – аортальная (22 %) и почечная (6 %) формы. Наибольшая численность сосудов надпочечных желез характерна для верхних основных и нижних добавочных надпочечниковых артерий. Установлена взаимосвязь между количеством основных надпочечниковых артерий и формой железы., У 9-10-місячних плодів людини виявляється змішана форма кровопостачання (72 %) надниркових залоз за участю трьох груп артерій (верхніх, середніх і нижніх), рідше – аортальна (22 %) та ниркова (6 %) форми. Найбільша чисельність судин надниркових залоз властива для верхніх основних та нижніх додаткових надниркових артерій. Доведено взаємозв'язок між чисельністю основних надниркових артерій та формою залози.

The urinary tract is divided into upper and lower parts. The kidneys and ureters make up the upper urinary tract while the urinary bladder and urethra constitute the lower urinary tract. This classification while somewhat arbitrary is nevertheless useful and convenient for descriptive purposes. In this article, a detailed description of the topographical and vascular anatomy of the kidney and ureter is followed by a brief account of the anatomy of the suprarenal gland.

Ganglioneuromas (GNs) are benign, differentiated tumors that are derived from neural crest sympathogonia. They can be found anywhere in the body along autonomic ganglia. These tumors are seen most often in individuals over 10 years of age and are usually asymptomatic. However, GNs can grow large and cause symptoms due to mass effect. GNs are rarely located within the suprarenal gland and are benign tumors that are often diagnosed late in their course due to mass effect or found incidentally on imaging studies. We describe a case of a 22-year-old female who presented to clinic with vague abdominal pain. She underwent an extensive workup which ultimately revealed a rare presentation of a left suprarenal GN that required surgical removal. She underwent an extensive workup which ultimately revealed a left suprarenal GN that required surgical removal. The patient underwent laparotomy and surgical excision of the mass and made a full recovery.

Absence of left kidney was noted during routine anatomy dissection of a male cadaver of South Indian origin. On examination of the abdomen and pelvic cavities; an ovoid mass of tissue was found in the pelvis, anterolateral to the sacrum. Further dissection revealed the presence of an ectopic left side kidney. The ectopic kidney was lying inferior to the sigmoid colon and anterior to the bifurcation of left common iliac vessel. It was supplied by numerous aberrant vessels from the terminal part of abdominal aorta. One of the renal veins which drain the ectopic kidney was found to be persisting subcardinal vein and it is a novel finding. Such ectopic pelvic kidneys are susceptible to blunt trauma, iatrogenic injuries as well as pathologic manifestations.

SUMMARY: The suprarenal glands are bilaterally supplied by three suprarenal arteries and drained by a single suprarenal vein. Variable vascular origins of the fetal suprarenal gland have been documented in different population groups viz. Indian, Polish and Argentinian. However, there is lack of a detailed description regarding the course, relations, number of branches and vertebral levels of the origins of the vasculature of the suprarenal glands in fetuses. This study aimed to identify and document the vascular supply of the suprarenal glands in fetuses in a South African setting. Fifty fetal specimens (26 males; 24 females) with a gestational age ranging between 12 and 20 weeks, were bilaterally micro-dissected (n=100) using a Zeiss Stemi DV4 microscope. Data was recorded and the frequencies of the origin, course, relations, number of branches and vertebral levels of the suprarenal vascular supply were determined. Arterial supply: Origin: (i) The superior suprarenal artery (SSA) bilaterally arose from the inferior phrenic arteries in 98 % of the fetuses; (ii) the middle suprarenal artery (MSA) frequently arose from the renal artery (RA) on the right side (46 %) and the abdominal aorta on the left side (34 %); while (iii) the inferior suprarenal artery (ISA) predominantly arose from the RA in 91 % of the specimens, bilaterally. Course and relations: The suprarenal arteries followed a superior, inferior, lateral, supero-lateral and infero-lateral course to the gland. These arteries were closely related to the crura of the diaphragm, the inferior vena cava, the left inferior phrenic vein and the pancreas. Number of branches: The branches ranged from one to seven for the SSA, one to four for the MSA and one to three for the ISA. Vertebral levels: The SSA predominantly arose from the first lumbar (L1) vertebral body (32 %), the MSA arose from the middle third of the intervertebral disc between the L1 and the second lumbar (L2) vertebrae (19 %) and the ISA arose from the L2 vertebral body (28 %). Venous drainage: In 1 % of the specimens, an additional right suprarenal vein (ARSV) was observed. This ARSV followed a superomedial course into the inferior vena cava, just below the entrance of the main right suprarenal vein. The arteries supplying the suprarenal gland presented varying origins and number of branches, corroborating with the reviewed literature and standard anatomical textbooks. The findings of this study may aid pediatric surgeons in understanding the vascular morphology (and the variations thereof) of the suprarenal gland, when performing adrenelectomy surgery in neonates.

SUMMARY: The suprarenal glands are bilaterally supplied by three suprarenal arteries and drained by a single suprarenal vein. Variable vascular origins of the fetal suprarenal gland have been documented in different population groups viz. Indian, Polish and Argentinian. However, there is lack of a detailed description regarding the course, relations, number of branches and vertebral levels of the origins of the vasculature of the suprarenal glands in fetuses. This study aimed to identify and document the vascular supply of the suprarenal glands in fetuses in a South African setting. Fifty fetal specimens (26 males; 24 females) with a gestational age ranging between 12 and 20 weeks, were bilaterally micro-dissected (n=100) using a Zeiss Stemi DV4 microscope. Data was recorded and the frequencies of the origin, course, relations, number of branches and vertebral levels of the suprarenal vascular supply were determined. Arterial supply: Origin: (i) The superior suprarenal artery (SSA) bilaterally arose from the inferior phrenic arteries in 98 % of the fetuses; (ii) the middle suprarenal artery (MSA) frequently arose from the renal artery (RA) on the right side (46 %) and the abdominal aorta on the left side (34 %); while (iii) the inferior suprarenal artery (ISA) predominantly arose from the RA in 91 % of the specimens, bilaterally. Course and relations: The suprarenal arteries followed a superior, inferior, lateral, supero-lateral and infero-lateral course to the gland. These arteries were closely related to the crura of the diaphragm, the inferior vena cava, the left inferior phrenic vein and the pancreas. Number of branches: The branches ranged from one to seven for the SSA, one to four for the MSA and one to three for the ISA. Vertebral levels: The SSA predominantly arose from the first lumbar (L1) vertebral body (32 %), the MSA arose from the middle third of the intervertebral disc between the L1 and the second lumbar (L2) vertebrae (19 %) and the ISA arose from the L2 vertebral body (28 %). Venous drainage: In 1 % of the specimens, an additional right suprarenal vein (ARSV) was observed. This ARSV followed a superomedial course into the inferior vena cava, just below the entrance of the main right suprarenal vein. The arteries supplying the suprarenal gland presented varying origins and number of branches, corroborating with the reviewed literature and standard anatomical textbooks. The findings of this study may aid pediatric surgeons in understanding the vascular morphology (and the variations thereof) of the suprarenal gland, when performing adrenelectomy surgery in neonates. RESUMEN: Las glándulas suprarrenales son irrigadas bilateralmente por tres arterias suprarrenales y drenadas por una sola vena suprarrenal. Los orígenes vasculares variables de la glándula suprarrenal fetal se han documentado en diferentes grupos de población: indios, polacos y argentinos. Sin embargo, no existe una descripción detallada del curso, las relaciones, el número de ramas y los niveles vertebrales de los orígenes de la vasculatura de las glándulas suprarrenales en los fetos. Este estudio tuvo como objetivo identificar y documentar el suministro vascular de las glándulas suprarrenales en fetos en una población sudafricana. Cincuenta especímenes fetales (26 hombres; 24 mujeres) con una edad gestacional que oscila entre las 12 y las 20 semanas, fueron micro-diseccionados bilateralmente (n = 100) utilizando un microscopio Zeiss Stemi DV4. Se registraron los datos y se determinaron las frecuencias de origen, curso, relaciones, número de ramas y niveles vertebrales del suministro vascular suprarrenal. Suministro arterial: Origen: (i) La arteria suprarrenal superior (SSA) surgió bilateralmente de las arterias frénicas inferiores en el 98 % de los fetos; (ii) la arteria suprarrenal media (MSA) surgió frecuentemente de la arteria renal (AR) en el lado derecho (46 %) y en la parte abdominal de la aorta en el lado izquierdo (34 %); mientras que (iii) la arteria suprarrenal inferior (AIS) surgió predominantemente de la AR en el 91 % de los especímenes, bilateralmente. Curso y relaciones: las arterias suprarrenales seguían un curso superior, inferior, lateral, superolateral e inferolateral hacia la glándula. Estas arterias estaban estrechamente relacionadas con la crura del diafragma, la vena cava inferior, la vena frénica inferior izquierda y el páncreas. Número de ramas: Las ramas variaron de una a siete para la SSA, de una a cuatro para la MSA y de una a tres para la ISA. Niveles vertebrales: la SSA surgió predominantemente del primer cuerpo vertebral lumbar (L1) (32 %), la MSA surgió del tercio medio del disco intervertebral entre la L1 y la segunda vértebra lumbar (L2) (19 %) y la ISA surgió del cuerpo vertebral L2 (28 %). Drenaje venoso: en el 1 % de las muestras, se observó una vena suprarrenal derecha (ARSV) adicional. Este ARSV siguió un curso superomedial hacia la vena cava inferior, justo debajo de la entrada de la vena suprarrenal derecha principal. Las arterias que irrigaban la glándula suprarrenal presentaban diversos orígenes y número de ramas, lo que corrobora la literatura revisada y los libros de texto anatómicos estándar. Los hallazgos de este estudio pueden ayudar a los cirujanos pediátricos a comprender la morfología vascular (y sus variaciones) de la glándula suprarrenal, al realizar una cirugía de adrenelectomía en neonatos.

BACKGROUND The suprarenal glands are located just above the kidneys from their position the name is derived. They have no other relation to the kidneys, either functionally or developmentally. Their development is taken up at this place because of their intimate embryological relation to the autonomic nervous system. The relative prominence of the foetal adrenal in comparison to other abdominal viscera is accounted for by a mass of cells called the foetal zone between the area, which is later to become the adult cortex and the medulla. The aim of the study is to evaluate the morphometric parameters of human foetal suprarenal gland - shape, length, breadth, thickness and weight and to compare these parameters between the right and left sides to study the relation between the foetal adrenal gland size and kidney size and the relation between the foetal adrenal weight and body weight. MATERIALS AND METHODS The material for the study consisted of 50 human foetal specimens from 9 th to 38 th week of gestational age. Morphometric measurements including length, breadth, thickness, weight were taken from the right and left suprarenal glands in each specimen and to the results obtained Student’s unpaired t-test was applied and data was analysed using GraphPad Prism 5.0 (free trial version). RESULTS In the 18 th week foetus, the right suprarenal gland acquired pyramidal and left suprarenal gland assumed semilunar shape and were yellowish in colour. There was a steady increase in the parameters from 9 th to 38 th week. A statistically significant difference was obtained for the length, breadth and weight between the right and left suprarenal glands with a ‘p’ value less than 0.05. CONCLUSION It was observed in the present study that the left gland measured more weight than the right throughout the gestational ages from 9 th week to 38 th week confirming the reports of earlier authors. The suprarenal glands at term weighed 1/3 rd the weight of the kidney. The suprarenal glands are relatively very large at birth and constitute 0.2% of the entire body weight compared with 0.01% in the adult.

Purpose. C11-Acetate is radiotracer being considered an alternative to 18F-fluorodeoxyglucose. Evaluation of C11-acetate biodistribution in human parenchymal organs is described. Methods and Materials. 60 consecutive patients referred to C11-acetate PET CT suspected of renal or prostate cancer relapse with negative results (no recurrent tumor) were included in the study. Acquisition from the base of skull to upper thigh was made 20 min after i.v. injection of 720 MBq of C11-acetate. The distribution was evaluated by measuring the uptake in pancreas (uncinate process and body separately), liver, spleen, and left suprarenal gland. Clinical data of included patients showed no abnormalities in these organs. Results. Biodistributions of C11-acetate radiotracer were compared in different organs. Standardized uptake values of 11C-acetate were significantly higher in pancreatic parenchyma (SUV mean 6,4) than in liver (SUV mean 3,3), spleen (SUV mean 4,5), or suprarenal gland (SUV mean 2,7) tissues. No significant difference was found between pancreatic head (SUV mean 6,4) and body (SUV mean 5,9) uptake. In case of all aforementioned organs, there were no differences either between both sexes or between formerly diagnosed tumors (renal and prostate). Conclusions. Evaluation of C11-acetate uptake differences in parenchymal organs will allow establishing normal patterns of distribution. High pancreatic uptake may be used in quantitative assessment of organ function in diffuse nonneoplastic pathology.

Primary retroperitoneal tumors (PRPTs) are a group of neoplasms that originate from the retroperitoneal space excluding those arising in the major retroperitoneal organs, such as the liver, duodenum, pancreas, spleen, kidney, suprarenal gland, ureters, and bone. Also excluded are metastatic malignancies from distant sites. Theoretically the tumors originating from the above retroperitoneal organs, e.g., duodenum, pancreas, and suprarenal gland, belong within the scope of “retroperitoneal tumors”; however, they are considered “visceral tumors” in academics. Many scholars still use the term “retroperitoneal tumor” instead of PRPTs. For convenience, in this book, PRPTs are hereinafter referred to as “retroperitoneal tumors.”

The first anatomical report of the adrenal glands comes from Eustachius in 1563. The anatomical division in two zones, an outer cortex and an inner medulla, came in 1805 by Cuvier [1]. Other prominent scientists that have contributed to the understanding of the role and function of the adrenal glands are Thomas Addison who described the features of adrenal insufficiency, Harvey Cushing who in 1932 reported 11 patients with the characteristic features of the syndrome that today bears his name, and Conn who in 1955 described the syndrome resulting from excessive secretion of this mineralocorticoid [2].

Editor-in-ChiefThe Frenchman Jean Franc¸ois Fernel (1497?-1558)(Fig. 1) was a physician and later royal physician toHenry II (Ruhra˚h, 1934). He was professor of medi-cine at the Colle`ge de Coenouailles for over 20 years.As a Renaissance physician, Fernel studied mathe-matics, philosophy, astronomy, anatomy and functionof the human body. In fact, Fernel coined the term“physiology.” He made many anatomical contributionsincluding observations on the spinal canal and brain.Fernel said, “Anatomy is to physiology as geographyis to history; it describes the theatre of events.” Hewrote that the brain was “the seat of the mind and itsparts; the mind being endowed with numerous facul-ties, man has rightly been provided with a largeraccommodation for it than the other creature pos-sess, and this accommodation is associated withmore instruments.” “The brain is the citadel anddwelling of the human mind, the abode of thoughtsand of the reason, the wellspring and origin of move-ment and of every sense; it occupies the highestpoint of the body, looking upwards, nearest to heav-en.” Some have suggested that modern anatomy andphysiology began with Fernel (Dampier, 1948). Fer-nel’s works include: De naturali parte medicinae(1542), De vacuandi ratione (1545), De abditis rerumcausis (1548), and Universa Medicina, composed ofthree parts, the Physiologia,thePathologia, and theTherapeutice (Sherrington, 1946). To honor the con-tributions of Fernel, a crater on the moon is named inhis honor.As a clinician with anatomic interests, we believethat Fernel would be pleased with this issue of ClinicalAnatomy. Herein, modern teaching methods such as3D interactive models of the lumbar spine and incor-porating Google Glass and ultrasound in the teachingof anatomy are presented. Other papers of interestinclude: reviews of the brain in premature infants,suprarenal gland development, Chiari malformations,and the menisci. Original studies on elastography ofthe rotator cuff muscles, and soft tissues overlyingthe greater trochanter and the influence on hip frac-tures in the elderly are sure to please our readershipand contribute to our understanding of the humanform.