Bilateral variation in the branching pattern of the subclavian artery: an unusual finding with clinical implications / Variação bilateral no padrão de ramificação da artéria subclávia: um achado incomum com implicações clínicas

Abstract The subclavian artery is a significant branch of the aortic arch. We present a rare case of a bilateral variation in the branching pattern of the subclavian artery, observed in an adult male cadaver aged 70 years. On both the sides of the neck, all the branches of the subclavian artery took their origin from its first part. There was a rare occurrence of a cervicodorsoscapular trunk, which gave rise to superficial cervical, suprascapular, and dorsal scapular arteries. The same branching pattern was observed on the left side of the neck, with the presence of another cervicodorsoscapular trunk. Thyrocervical trunk and transverse cervical artery were both absent from the cervical region bilaterally. The inferior thyroid artery was a direct branch from the subclavian artery. Knowledge regarding variations of the subclavian artery is very important as lateral cervical region arteries are important for flap harvesting in plastic and reconstruction surgery. Preoperative radiologic evaluation of pedicles might help in choosing the optimal flap design, prevent ischemic complications, and help to improve overall treatment outcomes.

Resumo A artéria subclávia é um ramo significativo do arco da aorta. Apresentamos um caso raro de variação bilateral do padrão de ramificação da artéria subclávia, observada em um cadáver adulto do sexo masculino de 70 anos. Em ambos os lados do pescoço, todos os ramos da artéria subclávia originavam-se de sua primeira parte. Houve rara ocorrência de tronco escapular cervical dorsal, que deu origem às artérias cervical superficial, supraescapular e escapular dorsal. O mesmo padrão de ramificação foi observado no lado esquerdo do pescoço, com a presença de tronco escapular cervical dorsal. O tronco tireocervical e a artéria cervical transversa estavam ausentes em ambas as regiões cervicais direita e esquerda. A artéria tireóidea inferior consistia em um ramo direto da artéria subclávia. O conhecimento das variações da artéria subclávia é fundamental, pois as artérias da região cervical lateral são importantes para a obtenção de retalhos em cirurgias plásticas e reconstrutivas. A avaliação radiológica pré-operatória dos pedículos pode ajudar na escolha do desenho ideal do retalho, prevenir complicações isquêmicas e ajudar a melhorar o resultado geral do tratamento.

Caesalpinia bonduc Linn Extracts Exhibit Hepatoprotective Effect on HepG2 Cells against Paracetamol by Up-regulating Glutathione Related Genes

Background: Caesalpinia bonduc (CB) is said to ownvarious pharmacological and therapeutic applicationagainst a number of diseases. It is used widely in folkmedicine to treat liver diseases. In the present study,we have made a sincere effort to evaluate thehepatoprotective activity of CB leaf extracts againstParacetamol (PCM) induced toxicity and theirmechanism of hepatoprotection in the humanHepatocarcinoma cells (HepG2 cells) therebyproviding scientific evidence for the same. Materialand Methods:The hepatoprotective activity of CB wasassessed in-vitro by the estimation of glutathione(GSH) and Malondialdehyde (MDA), anti-apoptoticassay/Annexin V and the expressions of genes such asGlutathione Reductase (GS-R) and GlutamateCysteine Ligase, Catalytic (GCLC). Results: Theobtained results suggest that the aqueous extract of CBpossess significant hepatoprotective activity. Thisactivity may be due to the possible antioxidantproperty and the free radical scavenging ability of theextracts, which might clear the toxic metabolites ofPCM. Conclusion: The present study suggests that theaqueous extract of CB have potential hepatoprotectiveactivity, which may prevent the lipid peroxidation ofthe cell membrane by its antioxidant properties.

Influence of traditional medicines on the activity of keratinocytes in wound healing: an in-vitro study / 대한해부학회지

Natural medicinal systems such as Ayurveda and folk medicine has remedies for wound management. However, the exact cellular and extracellular mechanisms involved in the healing process and its influence on keratinocytes is less discussed. Therefore, the present study was designed to evaluate the effect of certain natural wound healing medicines on the biology of the keratinocytes/HaCaT cells. Test materials such as honey (H), ghee (G), aqueous extracts of roots of Glycyrrhiza glabra (GG) and leaves of Nerium indicum (NI) were considered. The HaCaT cells were treated with the test materials singly and in combinations (H+G, all combined [Tot]) for a specific period (24, 48, and 72 hours). The cells were then subjected to cytotoxicity/proliferation and migration/scratch assays. All the test materials, except NI, were non-cytotoxic and showed increased cell proliferation at variable concentrations. Significant observations were made in the groups treated with honey (100 µg/ml at 48 hours, P<0.05; 1,000 µg/ml at 72 hours, P<0.05), GG (all concentrations at 48 hours, P<0.05; 750 µg/ml at 72 hours, P<0.05), H+G (250 µg/ml at 24 hours, P<0.001; 500 µg/ml at 48 and 72 hours, P<0.05), and Tot (50 µg/ml at 24, 48 and 72 hours, P<0.01). In the in-vitro wound healing assay, all the treated groups showed significant migration and narrowing of the scratch area by 24 and 48 hours (P<0.001) compared to control. The results obtained from the present study signifies the positive influence of these natural wound healing compounds on keratinocytes/HaCaT cells.

Additional muscle slip of bicipital aponeurosis and its anomalous relationship with the median cubital vein

The cubital region of the arm is a common site for recording blood pressure, taking blood for analysis and administering intravenous therapy and blood transfusions. During the routine dissection of a 70-year-old male cadaver at the Kasturba Medical College, Manipal, Karnataka, India, in 2015, it was observed that the aponeurotic insertion of the biceps brachii muscle divided into two slips. The medial slip fused normally with the deep fascia of the forearm, while flexor carpi radialis muscle fibres originated from the lateral slip. There was also a single vein in the forearm, the cephalic vein, which bifurcated to form the median cubital vein and the cephalic vein proper. The median cubital vein, further reinforced by the radial vein, passed deep to the two slips of the bicipital aponeurosis and then continued as the basilic vein. During venepuncture, medical practitioners should be aware of potential cubital fossa variations which could lead to nerve entrapment syndromes

Rare variations in the Origin, Branching Pattern and Course of the Celiac Trunk: Report of Two Cases

Multiple anomalies in the celiac arterial system presents as rare vascular malformations, depicting deviations of the normal vascular developmental pattern. We found a common left gastro-phrenic trunk and a hepato-spleno-mesenteric trunk arising separately from the abdominal aorta in one cadaver. We also found a common hepatic artery and a gastro-splenic trunk arising individually from the abdominal aorta in another cadaver. Even though many variations in the celiac trunk have been described earlier, the complex variations described here are not mentioned and classified by earlier literature. Knowledge of such variations has signifi cance in the surgical and invasive arterial radiological procedures in the upper abdomen.

Phytochemical screening and evaluation of analgesic, anti-antiinflammatory activities of Peganum harmala Linn., seeds in rodents.

The objective of this research work is to carryout the phytochemical screening and evaluate the analgesic, antiinflammatory activities of Peganum harmala Linn., seeds. In this study different extracts of Peganum harmala (Linn) seeds were evaluated for analgesic and anti-inflammatory activities using glacial acetic acid induced writhing and carrageenan induced rat paw edema models respectively. For analgesic and anti-inflammatory activities aspirin and diclofenac were used as standard drugs respectively. The ethyl acetate extract showed significant analgesic and anti-inflammatory activities, thus it can be considered as a potential candidate for analgesic and antiinflammatory activities. The presence of alkaloids, steroids, flavonoids in ethyl acetate extract of Peganum harmala (Linn) seeds could be attributed for the claimed analgesic and anti-inflammatory activities.

The histochemical assessment of sulpho-, sialo-, and neutralmucosubstances in fetal gastric mucosa.

Background: Mucins are complex composition of carbohydrates and may be present as a mixture of different types. Normal distribution of mucin and its alteration in various inflammatory, benign and malignant lesions of gastrointestinal tract has aroused interest in the field of histochemistry. The main purpose of present work is to study the staining pattern and distribution of cells in different parts of fetal gastric mucosa and to correlate the nature of gastric mucins and its functional significance. Methods: A total of 25 fetus stomach specimens (total 75 samples) one sample each from different parts of the stomach like fundus, body and pylorus, from fresh specimens. The samples were washed in normal saline, fixed in 2% calcium acetate in 10% formalin. These tissues were routinely processed and paraffin blocks were prepared. 6  sections of these blocks were taken for histological and different histochemical staining. Results: Fetal fundic part of stomach shows increased neutral mucin in surface epithelium and foveolar cells. With combined AB pH 2.5 - PAS technique increased neutral mucin and small amount of acid mucins are observed. With AB pH 1, surface epithelium and deep glands show negative staining. Moderate alcinophilia is observed in deep foveolar cells and glandular cells. AB pH 2.5 shows alcinophilia in surface epithelium, foveolar cells and mucous neck cells indicating presence of sialomucin. Fetal pyloric part of stomach shows increased acid and neutral mucins. With pH 2.5 - PAS staining, purple staining is observed in surface epithelium, deep foveolar and pyloric glands. Conclusion: All types of mucosubstances - neutral, sialo and sulpho-mucins, are secreted in relatively increased amounts by the surface epithelium and the glands of the stomach of the human fetus and neonate. Sulphomucin is seen mainly in the cells of the surface epithelium.

Effect of Cissus quadrangularis Linn on skeletal growth in the neonates of diabetic rats.

Background: Infants of the diabetic mother are known to have reduced bone mineral content and hypocalcemia. Earlier, it has been shown that petroleum ether extract of Cissus quadrangularis (PECQ) can enhance the fetal skeletal ossification in normal rats. The present study was designed to evaluate the effect of PECQ on skeletal growth in the neonatal rats of streptozotocin-induced diabetic rats. Methods: After confirmation of diabetes, the diabetic and non-diabetic female Wistar rats were kept for mating with healthy male rats. After positive vaginal smear test, the pregnant rats were divided into three groups; the normal (non-diabetic) control (NC), diabetic control (DC), and diabetic+CQ (D+CQ) groups. The rats in the D+CQ group were given PECQ (500 mg/kg B.Wt), whereas animals in NC and DC groups were given 0.5% carboxy methyl cellulose, throughout the gestational period. Femur from the 1 week old neonatal rats from each group was collected randomly and subjected to histological analysis. Results: Thickness of trabecular bone and periosteum was significantly reduced in the neonates of DC rats compared with the neonates of NC group. Pretreatment with PECQ significantly improved the thickness of trabecular bone and periosteum compared with neonatal rats of DC group. No significant differences were observed in the medullary cavity width of femur between the groups. Conclusion: Data from the present study suggest that the PECQ can effectively attenuate the diabetes-induced reduction in the early skeletal growth. However, further research is warranted to evaluate the exact mechanism of action of phytochemical constituents of PECQ that can cross the placental barrier.

Protective effect of Cissus quadrangularisLinn. on diabetes induced delayed fetal skeletal ossification.

Background: Delayed fetal skeletal ossification is one of the known complications of maternal diabetes. Objective: The present study was designed to evaluate the protective role of petroleum ether extract of Cissus quadrangularis (PECQ) on diabetes‑induced delayed fetal skeletal ossification. Materials and Methods: Female Wistar rats were rendered diabetic with streptozotocin (STZ, 40 mg/kg, intraperitonial) before mating. After confirmation of pregnancy, the pregnant rats were divided into three groups: normal control group, diabetic control group, and diabetic + CQ group. The diabetic + CQ group pregnant rats were treated with PECQ (500 mg/kg body weight) throughout their gestation period. Immediately after delivery, pups were collected from all three groups and processed for alizarin red S–alcian blue staining in order to examine the pattern of skeletal ossification. Results: Fewer ossification centers and decreased extent of ossification of forelimb and hindlimb bones were observed in the neonatal pups of diabetic control group as compared to those in the normal control group. PECQ pretreatment significantly restored the ossification centers and improved the extent of ossification of forelimb and hindlimb bones in the neonatal pups of diabetic + CQ group as compared to those in the diabetic control group. Conclusions: The results suggested that PECQ treatment is effective against diabetes‑induced delayed fetal skeletal ossification. However, further studies on the isolation and characterization of active constituents of PECQ, which can cross the placental barrier and are responsible for the bone anabolic activity are warranted.

Analysis of the morphometry and variations in the extensor digitorum brevis muscle: an anatomic guide for muscle flap and tendon transfer surgical dissection / 대한해부학회지

The extensor digitorum brevis muscle (EDB) is a practical option for use as an island flap or free flap when reconstructing soft tissue defects in the ankle as well as in the entire lower limb. It is frequently used to correct crossover toe deformity and other painful toe disorders. We evaluated the morphometry of the EDB in 44 formalin-fixed limbs. Length and width of the muscles were measured. Surface area was calculated as the product of length and width of the muscle. The length of each tendon was also measured from its origin to the point of distal attachment. Presence of any additional tendons was noted. Mean length, width, and surface area of the muscle were 7.39+/-0.71 cm, 4.1+/-0.37 cm, and 30.5+/-4.78 cm2 on the right side and 7.2+/-0.84 cm, 3.9+/-0.37 cm, and 28.4+/-5.35 cm2 on the left side, respectively. Morphometry of the tendons revealed that the tendon of the great toe had the highest mean length (9.5 cm) and the tendon of the fourth toe had the lowest mean length (6.3 cm). Four of the limbs studied (9.09%) had only three tendons. Three of the limbs studied (6.81%) had five tendons, and in one exceptional case (2.27%), six tendons were detected. These observations have significant value and are applicable to plastic and orthopedic surgery.

Unilateral duplication of vas deferens: a cadaveric case report / 대한해부학회지

Duplication of vas deferens is a rare congenital anomaly. All previously reported cases of this rare anomaly were identified during procedures such as orchiepexy, inguinal hernia repair, vasectomy, varicocoelectomy, and radical prostatectomy. Here, we report a case of unilateral duplicated vas deferens noted in an adult cadaver during regular dissection for medical students. The right spermatic cord contained 2 separate and completely developed cord-like structures. Both cords communicated separately with the tail of the epididymis. When traced cranially, both traversed the inguinal canal as content of the spermatic cord and finally fused at the level of the deep inguinal ring. No other variations were found in the testis or epididymis, and no variations were seen in the left spermatic cord. In addition, no associated renal abnormalities were noted.

Unusual third head of the sternocleidomastoid muscle from the investing layer of cervical fascia / Inusual tercera cabeza del músculo esternocleidomastoideo desde la lámina superficial de la fascia cervical

The abnormal origin, presence of additional head and layered arrangement of fibers are the reported variations of sternocleidomastoid muscle in the past. In the present case we report a rare unusual origin of third head of the sternocleidomastoid muscle in a 60 year-old male cadaver. This additional head originated from the investing layer of cervical fascia in the roof of the subclavian triangle close to the clavicle and traversed obliquely upward, forward and fused with clavicular head. The insertion and nerve supply of the muscle was found to be normal...

El origen anormal, presencia de una cabeza adicional y disposición en capas de fibras son las variaciones reportadas del músculo esternocleidomastoideo. En el presente estudio, se presenta un origen poco habitual de la tercera cabeza del músculo esternocleidomastoideo en un cadáver de sexo masculino de 60 años. La cabeza supernumeraria se originaba en la lámina superficial de la fascia cervical en el techo del triángulo subclavio próximo de la clavícula y cruzaba oblicuamente hacia arriba y adelante para fusionarse con la cabeza clavicular. La inserción e inervación del músculo eran normales...

Communication of the anterior branch of the great auricular nerve with the cervical branch of facial nerve and its variant nerve endings deep in the parotid gland / Comunicación del ramo anterior del nervio auricular mayor con el ramo cervical del nervio facial y sus terminaciones nerviosas profundas variantes en la glándula parótida

The communications between the branches of cervical plexus and cervical branch of facial nerve are common and are well known. However, this communication usually occurs between the transverse cervical nerve and cervical branch of facial nerve. During routine dissection classes for the Medical undergraduate students, we came across an anatomical variant of anterior division of great auricular nerve. This variation was found in a 60-year-old male cadaver of South Indian origin and it was unilateral. The great auricular nerve arose from the loop of ventral rami of C2 and C3 spinal nerves and divided into anterior and posterior branches. The anterior branch ran obliquely upwards and forwards on the surface of the sternocleidomastoid muscle along with the external jugular vein towards the apex of parotid gland and divided into many branches. One of these branches gave a communicating branch to cervical branch of facial nerve outside the parotid gland. Nerve endings of the remaining branches were found to penetrate the interlobular septa and a few of them were seen deep in the gland along the ducts and near the vessels. The functional significance of anatomic variations of nerve endings in relation to ducts, thin vessels deep in the parotid gland, observed in the present case are yet to be evaluated...

Las comunicaciones entre los ramos del plexo cervical y ramo cervical del nervio facial son comunes y bien conocidos. Sin embargo, esta comunicación por lo general ocurre entre el nervio cervical transverso y el ramo cervical del nervio facial. Durante las clases de disección de rutina para los estudiantes de pregrado de medicina, nos encontramos con una variante anatómica de la división anterior del nervio auricular mayor, unilateral, en un cadáver de sexo masculino de 60 años, del Sur de la India. El nervio auricular mayor se originó desde el bucle de los ramos ventrales de los nervios espinales C2 y C3, y dividió en ramos anterior y posterior. El ramo anterior se dirigió oblicuamente hacia arriba y adelante sobre la superficie del músculo esternocleidomastoideo junto con la vena yugular externa hacia el ápice de la glándula parótida y se dividió en numerosos ramos terminales. Uno de estos ramos dió un ramo comunicante al ramo cervical del nervio facial fuera de la glándula parótida. Las terminaciones nerviosas de los ramos restantes penetraron en los septos interlobulares. Algunos de éstos se observaron profundos en la glándula a lo largo de los conductos y cerca de los vasos. La importancia funcional de las variaciones anatómicas de las terminaciones nerviosas en relación a los conductos y vasos finos profundos en la glándula parótida aquí observados aún no se han evaluado...

Case report of high origin of radial, ulnar, and profunda brachii arteries, its clinical implications and review of the literature / Relato de caso de origem alta das artérias radial, ulnar e braquial profunda, suas implicações clínicas e revisão de literatura

Arterial variations in the arm are of potential clinical implications as it is a frequent site of injury and also involved in many surgical and invasive procedures. During a dissection of the right upper extremity, an abnormal high origin of the radial and ulnar arteries was found. The brachial artery had a very short segment without any branches, divided into the radial and ulnar arteries at the upper third of the arm. The course and branching pattern of these radial and ulnar arteries in the arm are discussed. It was also observed that the profunda brachii artery was represented by two separate branches arising from the posterior circumflex humeral artery. Accurate knowledge of these variation patterns is of considerable clinical importance in the conduct of reparative surgeries around the shoulder and fracture management of the humerus. These additional data of arterial anomalies to contemporary anatomical literature are of interest to clinicians, in particular vascular and plastic surgeons and radiologists.

As variações arteriais no braço têm potenciais implicações clínicas já que o braço é um sítio de lesões frequentes, além de estar envolvido em muitos procedimentos cirúrgicos e invasivos. Durante a dissecção da extremidade superior direita, uma origem alta anormal das artérias radial e ulnar foi encontrada. A artéria braquial apresentava um segmento muito curto sem quaisquer ramos, dividindo-se nas artérias radial e ulnar no terço superior do braço. O curso e o padrão de ramificação das artérias radial e ulnar no braço são discutidos. Também se observou que a artéria braquial profunda estava representada por dois ramos separados, surgindo da artéria umeral circunflexa posterior. O conhecimento preciso sobre esses padrões de variação é de considerável importância na realização de cirurgias reparadoras na região do ombro e no manejo de fraturas de úmero. Estes dados adicionais sobre as anomalias arteriais para a literatura anatômica contemporânea são de grande interesse para os médicos, especialmente para cirurgiões plásticos e vasculares e radiologistas.

Petroleum ether extract of Cissus quadrangularis (LINN) stimulates the growth of fetal bone during intra uterine developmental period: a morphometric analysis

OBJECTIVE: The aim of the present study was to analyze the effect Cissus quadrangularis plant petroleum ether extract on the development of long bones during the intra-uterine developmental stage in rats. METHODS: Pregnant rats (n=12) were randomly assigned into either a control group (n=6) or a Cissus quadrangularis treatment (n=6) group. Pregnant rats in the Cissus quadrangularis group were treated with Cissus quadrangularis petroleum ether extract at a dose of 500 mg/kg body weight from gestation day 9 until delivery. The animals in the control group received an equal volume of saline. Newborn pups were collected from both groups for alizarin red S - alcian blue staining to differentiate ossified and unossified cartilage. The ossified cartilage (bone) was morphometrically analyzed using Scion image software. RESULTS: Morphometric analysis revealed that the percentage of the total length of ossified cartilage (bone) in pups born to treated dams was significantly higher (P<0.001- -0.0001) than that of the control group. CONCLUSION: The results of the present study suggest that maternal administration of Cissus quadrangularis petroleum ether extract during pregnancy can stimulate the development of fetal bone growth during the intra-uterine developmental period.

Near drowning in cold water.

Drowning and near drowning is a common cause of accidental death all over the world; specially in road traffic accidents over bridges, swimming pool and boat tragedies. Cold water drowning resulting in hypothermia can lead to instant death before actual drowning. Five cases of near drowning (ND) in cold water, who presented with varied clinical picture like coma with decerebrate rigidity and fixed dilated pupils, hypertension with coma and delayed pulmonary oedema (Secondary drowning) are reported. Energetic management with continuous positive airway pressure was very rewarding in all patients with ND except in one who had transient organic psychosis persisting for two weeks followed by minimal cognitive defect in the form of slow mentation, lack of drive and mild irritability (Bender Gestald Test Score of 53). We have tried to analyse some of the clinical features of ND and the sequel associated with it. The management as well as recent developments in the field are also discussed.

Near drowning in cold water.

Drowning and near drowning is a common cause of accidental death all over the world; specially in road traffic accidents over bridges, swimming pool and boat tragedies. Cold water drowning resulting in hypothermia can lead to instant death before actual drowning. Five cases of near drowning (ND) in cold water, who presented with varied clinical picture like coma with decerebrate rigidity and fixed dilated pupils, hypertension with coma and delayed pulmonary oedema (Secondary drowning) are reported. Energetic management with continuous positive airway pressure was very rewarding in all patients with ND except in one who had transient organic psychosis persisting for two weeks followed by minimal cognitive defect in the form of slow mentation, lack of drive and mild irritability (Bender Gestald Test Score of 53). We have tried to analyse some of the clinical features of ND and the sequel associated with it. The management as well as recent developments in the field are also discussed.

Phosphate radical induced oxidation of pyrimidine bases in aqueous solution.

The photooxidation of pyrimidine bases viz., uracil and cytosine in presence of peroxydiphosphate (PDP) in aqueous solution at natural pH (approximately 7.5) has been carried out in a quantum yield reactor using a high-pressure mercury lamp. The rates of oxidation and quantum yields of pyrimidine oxidation have been found to increase with increase in [PDP] while they are independent of [pyrimidine] and light intensity. On the basis of these experimental results, product analysis and existence of isosbestic points a probable mechanism is suggested in which peroxydiphosphate ion on photolysis gives phosphate radical anions which initiates the reaction by adding to C(5) or C(6) of pyrimidine base leading to the formation of pyrimidine radical via radical cation or hydrolysis. This further reacts with PDP and gives the final products 5,6-dihydroxy pyrimidine and isobarbituric acid.

Perinatal mortality trends in a referral hospital.

A comparative study of perinatal mortality patterns over a period was conducted at a teaching hospital of South India. Among the 6,048 babies born from January 1984 to December 1985 (Group A), there were 265 (43.8/1000) still births and 127 (22.0/1000) early neonatal deaths. Three hundred and thirty seven (41/1000) babies were still born and 235 (29.8/1000) early neonatal deaths out of 8,215 deliveries during 1992-93 (Group B). The perinatal mortality rate (PMR) in Groups A and B were 57.9/1000 and 57.7/1000 respectively. Unbooked cases accounted for the majority (> 75%) of perinatal deaths during both the periods. The overall mortality rates in unbooked cases were three to four times higher than booked cases. Among the various causes of still births, antepartum haemorrhage and uterine rupture had increased. Septicaemia was the major cause of early neonatal deaths in Group A, but in Group B birth asphyxia and prematurity were the leading causes. Effective interventions like creating awareness among the target population to utilise maternal and child health services and early referral of high risk cases with improved intranatal and perinatal care can decrease the perinatal mortality.