case report of concurrent variation of biceps brachii and musculocutaneous nerve in a cadaver

Different neuromuscular variations have been reported in the arm. In this case, a rare concurrent neuromuscular variation in right arm and a muscular variation in left arm are reported in a cadaver. During dissection of a cadaver, we found that the biceps brachii muscle had an additional head [third head] in both sides associated with a neural variation in the right side. In this case, the musculocutaneous nerve did not exist and was replaced by the branches of lateral root of the median nerve. The finding of this report, might be a major of significance for both anatomists and surgeons to reduce the prospective complications of surgery

HsCRP in patients with acute exacerbation of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease [COPD] is currently the fourth leading cause of death in the United States. As there is systemic as well as local inflammation in COPD patients and evaluating the stage of the disease is not possible by spirometery alone, we evaluated High-Sensitivity C-reactive Protein [HS-CRP] in a group of COPD patients as an available and cost effective auxiliary marker in determining COPD stages. In a cross-sectional study in 160 COPD patients who were admitted for exacerbations in Razi Hospital in Rasht, Data on patients' demographic characteristics, pulmonary function test [PFT] and laboratory results consist of arterial blood gases and HSCRP levels were analyzed. A significant positive correlation was seen between serum HSCRP level and stages of the disease [as GOLD criteria]. There was a significant relationship between HSCRP level and patients' sex, BMI, and smoking history in a way that men and smokers showed higher and patients with normal BMI showed lower HSCRP levels. The patients with higher PCO2 also showed a higher level of serum HSCRP. This survey supports the role of HSCRP as a simple auxiliary marker in staging and determining the prognosis of COPD for early management

Substernal goiters: Clinical presentation, diagnosis, and surgical management

Intrathoracic goiter [ITG] or substernal goiter [SSG] includes any thyroid enlargement in which over 50% portion of the thyroid permanently located under the thoracic inlet and lower pole of thyroid is not palpable with the neck in hyperextended position. Between Jan 1993 and July 2002, 334 patients underwent thyroidectomy for goiters in Rasht [North of Iran]. In this investiagation, initial presentations, surgical managements and complications of 32 patients with substernal goiter have been evaluated retrospectively. Results: There were 20 women and 12 men, with a mean age of 40 years [range 45-67 yrs]. Twenty-two patients presented with respiratory symptoms, two had dysphagia, four complained of hoarseness, and five patients were detected incidentally by CXR. Chest X-ray was the first step in diagnosis, and C. T Scan was the best imaging examination for diagnosis. Isotope scanning was helpful only in five patients. Twenty-one patients were operated with the collar incision, seven with collar incision, and in some along with partially sternotomyfour and four patients were operated by median sternotomy. In 17 patients the goiters were in the right anterior mediastinum and in 14, in the left anterior mediastinum, in one patient goiter was seen in the hilum of the right lung. Pathologic reports were as follows: multinodular goiter in 22 patients papillary cell carcinoma in seven patients anaplastic carcinoma in one patient and lymphoma in one patient. Medullary cell carcinoma in one patient. There was no hospital mortality. Postoperative complications occured in five patients. This study recommends that intrathoracic goiter should be operated early under suitable conditions because of malignant transformation and other hemorrhagic or serious complications