Variation In The Mode Of Origin And Level Of Formation Of Nerve To Medial And Lateral Head Of Gastrocnemius Muscle

Variations of nerve are not only of anatomic and embryological interest but also of clinical importance. Theiradequate knowledge certainly help in increasing surgical precision and decreasing morbidity. In present studyvariations in mode of origin and level of formation of nerve to medial and lateral head of gastrocnemius wasstudied. The material for the present study comprised of 60 lower extremities belonging to 30 adult humancadavers obtained from Department of Anatomy, PIMS, Jalandhar. Neurectomy of nerve to medial gastrocnemiusmuscle is used to reduce volume of the muscle. For facial reconstruction after total parotidectomy, the facialnerve is being reconstructed by using vascularized sural nerve with free lateral gastrocnemius muscle flap

Variations in the origin and number of medial calcaneal nerve.

Variations of nerve are of anatomical, embryological and clinical importance. There adequate knowledge will help in increasing surgical precision and decreasing morbidity. In present study, the variation in the origin and number of medial calcaneal nerve (MCN) was studied. The material for present study comprised of 60 lower extremities belonging to 30 adult human cadavers obtained from department of Anatomy, GMC Amritsar. In the present study, number of MCN is highly variable. 1 MCN innervated 35%, 2 MCN innervated 40%, 3 MCN innervated 15%, 4 MCN innervated 8.3%, 5 MCN innervated 1.67%. There were total 121 medial calcaneal nerves found in the present study. MCN originated from tibial nerve in 57 instances (47.10%), from bifurcation of tibial nerve in 30 (24.79%), from lateral plantar nerve in 32 (26.44%) and from medial plantar nerve in 2 instances (1.65%). Description of variation of origin of medial calcaneal nerve in medial aspect of calcaneus is required to establish an anatomical guide for diagnosis and therapy of some tarsal region diseases including tarsal tunnel syndrome, fixation of fracture with external nailing, medial displacement osteotomy and nerve block in podiatric medicine.

Hyperhomocysteinemia as a risk factor for ischemic stroke: an Indian scenario.

BACKGROUND: Hyperhomocysteinemia has been proposed as an important risk factor for ischemic stroke worldwide, but data available from the Indian subcontinent is scarce. AIM: To study homocysteine levels in patients with ischemic stroke and compare it with age- and sex-matched controls. SETTINGS AND DESIGN: Case-control prospective study. MATERIALS AND METHODS: Fifty-seven patients with ischemic stroke and 30 controls were recruited for the study. They were subdivided into two subgroups (< 40 years and> 40 years of age) and plasma fasting total homocysteine (tHcy) levels were measured. STATISTICAL ANALYSIS USED: Student's 't' test and chi-square test. RESULTS: The tHcy were significantly high in patients with stroke, compared to controls (9.91 +/- 2.25 vs 8.00 +/- 2.74 micromol/l; P vs 8.45 +/- 2.72 micromol/l; P = 0.01) and female patients compared to controls (9.08 +/- 1.81 vs 6.79 +/- 2.60 micromol/l; P = 0.04). The tHcy levels were significantly high in patients with hypertension compared to normotensive patients (10.96 vs 9.49 micromol/l; P = 0.01) and smokers compared to nonsmokers (11.17 vs 9.33 micromol/l; P = 0.01). CONCLUSIONS: Hyperhomo-cysteinemia emerged as an important independent risk factor for ischemic stroke. A strong positive correlation was also observed between hypertension, smoking, and high-tHcy levels in the present study.

Calcium supplementation in pre-eclampsia.

OBJECTIVE: The objective of this prospective, open, randomised trial was to determine the role of calcium supplementation in preventing pre-eclampsia. METHODS: One hundred uncomplicated normotensive primigravidae were enrolled in the study before 20 weeks of pregnancy. Fifty each were randomised to receive either two gram elemental calcium daily from 20 weeks of gestation to delivery (study group) or no calcium supplementation (control group). Prior to 20 weeks of gestation each underwent a complete clinical and laboratory evaluation. Serum and urine calcium was measured first at 20 weeks of gestation and then at 24-28 weeks and at 32-36 weeks of pregnancy. RESULTS: Patient characteristics at the start of therapy were similar in the two groups. Blood pressure profile was similar throughout pregnancy in the groups. The incidence of pre-eclampsia was similar (18% in the study group and 16% in the control group), but severe pre-eclampsia was significantly less in the study group. There was no significant difference between the two groups with regards to intra- and postpartum characteristics, perinatal outcome and maternal or fetal side effects. Serum and urinary calcium levels did not differ between the two groups. CONCLUSION: While calcium supplementation did not lower the incidence of pre-eclampsia it did reduce its severity.

Salmonella typhimurium enterotoxin mediated fluid secretion.

Unidirectional Na+ and Cl- fluxes were studied in rats treated with S. typhimurium enterotoxin (S-LT). There was net absorption of Na+ and Cl- in the control group, while in the toxin treated animals there was net secretion of Na+ and Cl- (P less than 0.001). There was no change in the transport of D-glucose in the toxin treated group as compared to the control animals. The Na+, K(+)-ATPase pump was unaltered in the S-LT treated animals (198.67 +/- 11.23 nmoles Pi/mg protein/min) as compared to the control group (189.93 +/- 10.09 nmoles Pi/mg protein/min). There was no change in the unidirectional fluxes of Ca+2 in the S-LT treated animals as compared to the control animals, suggesting no change in the permeability of the S-LT treated intestinal membrane to Ca+2.

Role of oxygen dependent mechanisms in virulence of Salmonella typhimurium.

Catalase and superoxide dismutase (SOD) activities of five strains of S. typhimurium, namely SF 1546 LT2 71, SF 1835 C5 50, 386 SF 1591 Ra 20, SF 1567 Rd1, and an Indian strain were determined and correlated with their virulence profile. All five Salmonella strains exhibited catalase and SOD activities. No correlation was observed between either SOD and/or catalase activity and LD50 values of the isolates. Oxygen free radical generation elicited by macrophages, in the presence of virulent and avirulent salmonellae was also not statistically significant (P greater than 0.05), although the virulent species significantly resisted the macrophage bactericidal activity (P less than 0.05). It appears, therefore, that oxygen-dependent bactericidal mechanisms may not be important in phagocytic killing of S. typhimurium.

Catecholamine-induced experimental cardiomyopathy--a histopathological, histochemical and ultrastructural study.

An experimental model of myocardiopathy was induced in rhesus monkeys following noradrenaline (NA) infusion (20 ug/kg body wt/minute), for a period of 2 hours daily for three consecutive days. The animals were sacrificed after two hours (acute phase), forty-eight hours (sub-acute phase) and twenty-one days (chronic phase). Focal depletion of succinic dehydrogenase, increase in adenosine triphosphatase, acid phosphatase and appearance of large fat droplets in myocardial muscle was noted in the acute phase. Histopathological examination revealed focal edema, opacity and fuchsinorrhagia of the muscle fibres distributed in both the ventricles. Myofibrillar degeneration, myocytolysis and vacuolization with aggregation of lymphomononuclear cells were the significant features in the acute phase. During sub-acute and chronic phases, these features became less prominent and reparative changes with proliferation of fibroblasts became more marked. By the twenty-first day, irregular, focal scars replaced the necrosed myocardium. Ultrastructurally, heart muscle showed myofibrillar disorganisation, distortion of Z and A bands, dilatation of sarcoplasmic reticulum and swelling and rupture of mitochondria. Altered membrane permeability was evidenced by the presence of reaction products of horseradish peroxidase within the cardiac cells. In the reparative phase, however, myocytolytic changes regressed and collagen deposition was the prominent feature. This experimental study has several histological features simulating human cases of myocardial infarction without coronary occlusion.

Clonidine suppression test--an evaluation of its diagnostic significance in hypertensive patients.

The Clonidine Suppression Test (CST) was performed in 8 patients with Labile hypertension (Group I), 8 patients with mild and moderate Essential hypertension (Group IIa), 8 patients with severe Essential hypertension (Group IIb) and 6 patients with pheochromocytoma (Group III). The mean plasma catecholamine (CA) levels as estimated by a Spectrofluorimetric method were significantly reduced 3-4 hours after administration of clonidine (5 micrograms/kg) by mouth in Group I, IIa & IIb patients. Plasma norepinephrine levels fell from 1.82 +/- SEM 0.35 ng/ml to 1.03 +/- 0.11 ng/ml (p less than 0.05) in Group I, 1.64 +/- 0.36 ng/ml to 0.88 +/- 0.12 ng/ml (p less than 0.025) in Group IIa, 1.23 +/- 0.16 ng/ml to 0.86 +/- 0.12 ng/ml (p less than 0.005) in Group IIb patients. Plasma epinephrine levels fell from 0.35 +/- 0.06 ng/ml to 0.16 +/- 0.03 ng/ml (p less than 0.05) in Group I, 0.34 +/- 0.04 ng/ml to 0.22 +/- 0.03 ng/ml (p less than 0.01) in Group IIa, 0.33 +/- 0.06 ng/ml to 0.18 +/- 0.03 ng/ml (p less than 0.025) in Group IIb patients. The blood pressure and heart rate showed a similar response. By contrast, in patients with pheochromocytoma, the mean plasma CA levels did not show any significant fall, and even rose during the CST, but, when repeated post-operatively, showed normal suppression. No serious side effects were noticed. We conclude that the CST is a safe and reliable test for the diagnosis of pheochromocytoma.(ABSTRACT TRUNCATED AT 250 WORDS)