Supernumerary head of Biceps brachii: a rare occurrence in the Nepalese population.

Unilateral three headed biceps brachii muscle was observed in the dissected cadaver of a 45-year-old Nepalese cadaver. The supernumerary head is taking origin from the tendon of deltoid and crossing in front of the long head of biceps and joining with short head of biceps brachii. The incidence of this variation is very rare and there was no available literature in Nepalese population. Presence of such variation should be kept in mind by surgeons and traumatologists.

Anomalous branching of the axillary artery: a case report.

We present a case regarding the anomalous branching in the third part of the axillary artery on the left side in a 35-year-old male Nepalese cadaver. In the third part the axillary artery divided into superficial brachial and deep brachial arteries. The superficial brachial artery continued in the arm without giving any branches and ended in the cubital fossa dividing into radial and ulnar arteries. The deep brachial artery gave rise to subscapular, profunda brachii, articular branch to the shoulder joint, anterior circumflex humeral artery and posterior circumflex humeral artery. This variation is very rare and incidence is around 0.12-3.2% in the available literature. The normal and abnormal anatomy of the axillary region is having practical importance for the vascular radiologist and surgeon and it should be known for accurate diagnostic interpretation.

Cerebellar control of visceral responses-possible mechanisms involved.

It seems reasonable to assume that cerebellar autonomic control operates according to similar principles as those utilized in the somatomotor coordination. The unique and very uniform neuronal architecture throughout the cerebellum speaks in favour of such a view.

Our experience with epidural steroid injections in management of low backpain and sciatica.

BACKGROUND: Low back pain and sciatica is a common clinical condition. It is a most common orthopaedic complaint in the Kaski region of Nepal. The reason for its increased incidence may be hilly terrain, difficult working and living environment of the region. The initial treatment of Low back pain is conservative. Epidural steroid injection is being slowly established as are liable mode of conservative management in many orthopaedic centres of the world. This is a preliminary report of on-going study of the use of epidural steroid in the management of low back pain cases coming to the orthopaedic department of Manipal Teaching Hospital. METHODS: Prospective clinical trial was carried out on the patients reporting with low back pain and sciatica not responding to other modes of conservative treatment. Pre and post injection evaluation was done clinically. The level of pain, improvement in physical signs and ability to do activities of daily living were noted. RESULTS: Fifty two patients were observed for the average duration of 2.87 months. Average duration of symptoms was for 10 months. After first epidural steroid injection 83% of patients reported relief on day one. In some cases the onset of analgesia was delayed. Four patients reported no relief after first injection. Fifteen patients were given two injections and four received three injections. The average duration between two injections was three weeks.Average duration of pain relief was 20 days. At the end of 3 months, good results were seen in 39%, fair in 33% and bad results in 27%. Overall 59% of patients were able to do activities of daily living. Three patients (5.76%)required operation for disc prolapse. Postoperatively two patients reported back with back pain. Most common complaint of patients after injection was pain at the injection site. No major complications were encountered. CONCLUSION: Epidural Steroid Injection is a safe and effective mode of treatment of Low Back Pain. It provides painfree period to enable the patient for physiotherapy which helps in early recovery.

Emotional impact of cadaver dissection: a survey in a medical college in western Nepal.

OBJECTIVES: Adverse physical and psychological effects to human dissection have been reported in many studies. In Nepal, the basic science subjects are taught in an integrated manner in the first four semesters of the MBBS course. Studies on the attitudes of medical students towards anatomy dissection are lacking in Nepal. The present study was carried out to obtain information on the present and initial perception of medical students on exposure to anatomy dissection and the association, if any, of the perception with demographic factors. METHODS: The study was carried out among the first, second and third semester students at the Manipal College of Medical Sciences, Pokhara using the appraisal of life events (ALE) scale in February 2005. Sixty-three first semester, 57 second and 65 third semester students successfully completed the questionnaire and their responses were taken up for analysis. Information on sex, age, nationality, religion, food habits, occupation of parents and selection procedures of respondents was collected. The parameters loss, challenge and threat were measured on first exposure to dissection and at the time of the study. The scores were compared among different categories of students (p< 0.05). RESULTS: 185 of the 225 students (82.2%) successfully completed the questionnaire. The median initial loss, challenge and threat scores were 2, 19 and 4 respectively. The median present loss, challenge and threat scores were 1, 20 and 0 respectively. The present threat score was higher among second semester students. The initial loss was higher among Indians and the present challenge score was higher among vegetarians. CONCLUSIONS: The loss and threat score were low compared to that reported in a previous study. The challenge scores were higher than those reported previously. Majority of students considered anatomy dissection as a significant life experience and one which was largely positive. Further studies with a larger student population and in other medical colleges are required.