A study of high division of sciatic nerve in human cadavers and its clinical significance

Background: Sciatic nerve is a mixed nerve which provide sensory and motor supply for skin and muscles of the lower limb by tibial and common peroneal nerve. Anatomical variations of sciatic nerve at high division have been reported by various authors. The path of the sciatic nerve is important while administration of intramuscular injection to prevent nerve injury and nerve blockage failure during anesthesia. This knowledge of high division helps in different surgical approach for sciatic nerve injury or hip dislocation. Aims and Objectives: The aim of the study was to describe incidences of high division variation of Sciatic nerve and different types in cadavers during routine dissection schedule. Materials and Methods: The study was conducted during routine dissection schedule in anatomy department for first MBBS students to observe sciatic nerve course in 30 gluteal regions from 15 adult cadavers fixed by formalin. Location of sciatic nerve in relation to piriformis muscle and its division whether in single nerve sheath or separate sheath and types was recorded. Results: In 12 cadavers (80%), sciatic nerve course found normal which leaves pelvis at inferior border of piriformis muscle and bifurcate in terminal branches tibial nerve and common peroneal nerve as it approaches at the apex of popliteal fossa. In 3 cadavers (20%), two male and one female, we found high division of sciatic nerve where terminal branches, tibial nerve, and common peroneal nerve leave the pelvis below piriformis separately in different sheaths. Conclusion: Knowledge of variations-related high division of sciatic nerve would help surgeons during different interventions related to sciatic nerve and for preventing further complications.

Fabrication of 1,4-alpha-D-glucan glucanohydrolase holding Gel-Scaffolds using Agar-Agar, a natural polysaccharide and Polyacrylamide, a synthetic organic polymer for continuous liquefaction of starch

1,4-alpha-D-glucan glucanohydrolase is among the most widely used commercial hydrolytic enzymes acting randomly on the glycosidic linkages of starch resulting in its saccharification and liquefaction. Its applicability in different industries can be improved by enhancing its stability and reusability. Therefore, in the present study attempts have been made to enhance the industrial applicability of 1,4-alpha-D-glucan glucanohydrolase from Bacillus subtilis KIBGE-HAR by adapting immobilization technology. The study developed mechanically stable, enzyme containing gel-frameworks using two support matrices including agar-agar, a natural polysaccharide and polyacrylamide gel, a synthetic organic polymer. These catalytic gel-scaffolds were compared with each other in terms of kinetics and stability of entrapped 1,4-α-D-glucan glucanohydrolase. In case of polyacrylamide gel, Km value for immobilized enzyme increased to 7.95 mg/mL, while immobilization in agar-agar resulted in decreased Km value i.e 0.277 mg/mL as compared to free enzyme. It was found that immobilized enzyme showed maximum activity at 70 °C in both the supports as compared to free enzyme having maximum activity at 60 °C. Immobilized 1,4-α-D-glucan glucanohydrolase exhibited no change in optimal pH 7.0 before and after entrapment in polyacrylamide gel and agar-agar. The enzyme containing gel-scaffold was found suitable for repeated batches of starch liquefaction in industrial processes. Agar-agar entrapped 1,4-α-D-glucanglucanohydrolase was capable to degrade starch up to seven repeated operational cycles whereas polyacrylamide entrapped enzyme conserved its activity up to sixth operational cycle.

Variations in Innervation Pattern to Dorsum of Foot by Medial Dorsal Cutaneous Nerve, Intermediate Dorsal Cutaneous Nerve, Lateral Dorsal Cutaneous Nerve with Surgical and Clinical Correlations: A Cadaveric Dissection Based Study

The complete reconstruction of any soft tissue defect includes even the sensory recovery which is very significant aspect pertaining to prognosis. Superficial nerves in the vicinity of the vascular axis can be considered as vascular relays and neuroskin grafts can be constructed on them. Variations in innervation to various part of the dorsum of the foot by this nerve should be kept in mind while making these grafts. Authors dissected 50 formalinized cadaveric feet and studied normal anatomy and variations in origin, course, branching pattern, communications, and any other variations in medial, intermediate and lateral dorsal cutaneous nerve. The intermediate dorsal cutaneous nerve was innervating larger area of the skin around 3rd and 4th web spaces in 60% of cadaveric feet. The 2nd web space was innervated by medial dorsal cutaneous nerve in 92% of cadaveric feet. In 52% of cadaveric feet communicating branches were found between intermediate dorsal cutaneous nerve and lateral dorsal cutaneous nerve. In 63% cadaveric feet communicating branches were found between medial dorsal cutaneous nerve and branch of deep peroneal nerve to 2nd web space. The mean distance between lateral malleolus and intermediate dorsal cutaneous nerve was 4.05cm. These all observations can provide anatomical basis at the time of preparing medial dorsal cutaneous nerve flaps and intermediate dorsal cutaneous nerve flaps and also can minimize morbidity at donor site.

Tratamento de complicações durante intervenção coronariana percutânea: avaliação da situação atual / Management of complications during percutaneous coronary intervention: a current appraisal

Tecnologias mais avançadas, drogas melhores e profissionais mais experientes contribuíram para desfechos otimizados das intervenções coronarianas percutâneas complexas. As complicações com impacto significativo na sobrevida do paciente e alto custo para o sistema de saúde não foram totalmente eliminadas pelos procedimentos modernos de intervenções coronarianas percutâneas. Os procedimentos preventivos e a experiência do operador são as únicas formas de se evitarem os efeitos colaterais graves das intervenções coronarianas percutâneas. As dissecções, o fechamento abrupto da artéria, a perfuração coronariana, o non-reflow, a embolia gasosa, a deformação do stent, a embolização do dispositivo e o aprisionamento da ogiva de aterectomia rotacional são algumas das complicações abordadas neste artigo.

More advanced technology, better drugs and more experienced operators have contributed to improved complex percutaneous coronary intervention outcomes. Complications with significant impact on patient survival and healthcare costs have not been completely eliminated by modern percutaneous coronary intervention procedures. Professional expertise and consistent preventive procedures are the only ways to avoid severe side effects of percutaneous coronary intervention. Dissections, abrupt arterial closure, coronary perforation, no-reflow, air embolism, stent deformation, device embolization, and rotating atherectomy burr entrapment are some of the periprocedural complications covered in this article.

An Osteological Study Of Morphometric Variations Of Suprascapular Notch In South Gujarat Region

Background:The suprascapular notch is a depression in the lateral part of superior border of scapula. The suprascapular ligament bridges the notch. Thesuprascapular nerve passes below the ligament and corresponding artery above the ligament. Variation in size and shape of suprascapular notch is identified as one of the causes of suprascapular nerve entrapment.Aim Of Study:To study morphological variations of suprascapular notch in dry scapulae of South Gujarat (Indian) population and compare data with studies in other ethnic populations. Materials And Methods:Total 200 dry human scapulae were obtained from Anatomy departments of three medical collegesof south Gujarat. Three dimensions were defined and measured for each suprascapular notch (SSN) using classical osteometry: maximal depth (MD), superior transverse diameter (STD) and middle transverse diameter (MTD). Based on Micha? Polguj’s classification SSN was classified into five types. The results of the present study were compared with previous studies in different populations.Results:The proportion of Type III SSN is highest (46.5 %) followed by Type V (26 %), Type I (16 %), Type IV (6 %) and Type II (5.5 %). For Type III SSN, proportion of subtype III c is highest (36.5 %), followed by subtype III b (6 %) and subtype III a (4 %). For Type I SSN, proportion of subtype I c is highest (8.5 %), followed by subtype I a (4 %) and Subtype I b (3.5 %).Conclusion:The suprascapular nerve entrapment syndrome, in most cases is due to morphological variations of suprascapular notch particularly complete ossification of suprascapular ligament. So the knowledge of such variations is essential for clinicians,to make a proper diagnosis of shoulder pain and to plan the most suitable surgical intervention.

Isquemia crítica de miembros inferiores en paciente joven: presentación atípica del síndrome de atrapamiento poplíteo / Critical lower extremity ischemia in a young patient: atypical presentation of the popliteal artery entrapment syndrome

Introducción. El síndrome de atrapamiento poplíteo es una entidad infrecuente, cuya incidencia oscila entre 0,17 y 3,5 %, representando una de las principales causas de isquemia en miembros inferiores en adultos jóvenes. Suele manifestarse con claudicación intermitente (69 %) o isquemia aguda (26 %), siendo muy rara su presentación con isquemia crítica de miembros inferiores. Caso clínico. Paciente de 30 años quien presentó úlcera subungueal en primer dedo de pie derecho con dolor intenso. En la exploración física no se palpaban pulsos distales y se observó palidez cutánea intensa y frialdad. Se realizó arteriografía donde se observó defecto de repleción de bordes regulares y desplazamiento medial de la arteria poplítea. La resonancia magnética mostró una inserción anómala del gastrocnemio medial, con lo que se hizo diagnóstico de síndrome de atrapamiento poplíteo tipo I. Mediante abordaje posterior se realizó reconstrucción vascular con injerto venoso y sección tendinosa del gastrocnemio medial. En el postoperatorio inmediato el paciente recupera pulso pedio y en el seguimiento a un año el paciente no presenta clínica de isquemia de miembros inferiores, encontrándose el baipás permeable. Discusión. A pesar de su baja incidencia, es importante incluir el síndrome de atrapamiento poplíteo en el diagnóstico diferencial de isquemia en miembros inferiores en adultos jóvenes. Su presentación con isquemia crítica es excepcional, encontrando muy pocos casos publicados en la literatura. La reconstrucción arterial precoz mediante injerto o plastia con material autólogo constituye el tratamiento de elección

Introduction. The popliteal entrapment syndrome is an infrequent entity, whose incidence ranges between 0.17 and 3.5%, representing one of the main causes of lower limb ischemia in young adults. It usually manifests with intermittent claudication (69%) or acute ischemia (26%), being very rare its presentation with critical ischemia of the lower limbs.Clinical case. A 30-year-old patient with a history of smoking, with no other risk factors, who presented with a subungual ulcer on the first right toe. On physical examination, distal pulses are not palpated, intense skin paleness and coldness are observed. Magnetic resonance imaging showed an anomalous insertion of the medial gastrocnemius with extrinsic compression of the popliteal artery, confirming a diagnosis of popliteal entrapment syndrome type I. Vascular reconstruction with venous graft and tendon section of the medial gastrocnemius was performed through a posterior approach. In the immediate postoperative period, the patient recovers a pediatric pulse and in the one-year follow-up the patient does not present symptoms of lower limb ischemia, finding the bypass patent. Discussion. Despite its low incidence, it is important to include popliteal impingement syndrome in the differential diagnosis of lower limb ischemia in young adults. Its presentation with critical ischemia is exceptional, finding very few cases published in the literature. Early arterial reconstruction by graft or plasty with autologous material is the treatment of choice

Constrictive entrapment neuropathies of a limb secondary to restraint strapping: A case report

@#<p style="text-align: justify;"><strong>Rationale:</strong> Entrapment neuropathies are peripheral nerve disorders at specific anatomical locations. They may be caused by trauma in a manner of sprains or bone fracture, but it is often caused by repetitive insults or compression of nerves as they travel through a narrow anatomic space. Pregnancy and pre-existing comorbidities such as diabetes, obesity, cancer, or autoimmune diseases may also cause nerve entrapment.</p><p style="text-align: justify;"><strong>Objective:</strong> To highlight the case of a 52-yearold female developing right foot dysesthesia and weakness after continuous restraint strapping from her previous hospitalization.</p><p style="text-align: justify;"><strong>Case:</strong> Here we have the case of a 52-year-old Filipino female consulted because of right foot dysesthesia, allodynia, and mild weakness. She had a history of bipolar disorder and recent onset of acute psychosis and overdosing with her irregularly taken maintenance olanzapine tablets. She was put on restraint strapping of the right lower limb in her one-week hospital stay. This resulted in developing restraint marks on her right ankle accompanied by difficulty walking on heels and toes, spontaneous dysesthesia, and touch allodynia of her entire right foot. An electrodiagnosis yielded right lower limb focal neuropathies involving the right fibular nerve, right tibial nerve, right superficial fibular, and right sural nerves. The prescribed amitriptyline and gabapentin for 6 months led to gradual improvement of neuropathic pain.</p><p style="text-align: justify;"><strong>Discussion and Summary:</strong> Our case exemplifies focal limb neuropathies from entrapment due to restraint strapping. Electrodiagnostic confirmation of neuropathies of the same limb sensory and motor nerves was mandated to corroborate clinical neuropathic pain and after ruling out other causes of entrapment neuropathies. Prolonged use of neuropathic pain medications were needed to attain relief in this present case. Restrictive strapping is an iatrogenic cause of entrapment neuropathy that is preventable, had there been proper medical attention applied.</p>

Randomized Controlled Trial on Combined Percutaneous Release and Steroid Injection Versus Percutaneous Release Alone for Trigger Finger in Adults

@#INTRODUCTION: Trigger finger is one of the most common causes of hand pain and disability. Surgical treatment consists of release of the A-1 pulley by open or percutaneous techniques. Many authors have noted that percutaneous release is convenient and cost-effective with a low complication rate. Only few studies have published results on combination of percutaneous release and steroid injection. OBJECTIVE: To compare the differences of outcomes in adults with trigger finger treated with combination of percutaneous release and corticosteroid injection to those treated with percutaneous release alone METHODS: We included all patients older than 18 years old in the UP-PGH Department of Orthopedics with a diagnosis of trigger finger who have consented to participate in this study. They were randomized into two treatment groups. One group was treated with percutaneous release only and the other group was treated with combined percutaneous release and corticosteroid injection. Outcomes measured were total active motion (TAM), postoperative pain, time to return-to-work, patient satisfaction, and complications. RESULTS: Post-procedure, both groups showed significant improvement in motion of the fingers (p = 0.034) and pain relief (p = 0.001). TAM scores of the combination group were better compared to the control at all time intervals (p = 0.03, 0.008, 0.004, 0.019) and better pain VAS scores in the 1st week (p = 0.009). Patients who received the combination treatment showed a trend toward better patient satisfaction, shorter duration of post-release pain and earlier return-to-work. CONCLUSION: significantly improves TAM and pain VAS scores.

Progress in research on the determination of entrapment efficiency of liposomes / 中国药科大学学报

@#Liposome, a new dosage form, has become important in improving in vivo behavior of drugs or realizing targeted drug delivery. Study and control of its critical processes and quality attributes are the main challenges in the current research on liposomes. The degree of encapsulation can determine drug''s effect in vivo directly, thus entrapment efficiency (EE) has turned into one of the critical quality attributes of liposome.In this paper some methods commonly used for the determination of EE and their characteristics are summarized and analyzed, and the main factors to be considered for the determination are discussed.

Current Use of the Pulmonary Artery Catheter and Related Complications during Cardiac Surgery in Japan : a Questionnaire Survey / 日本心臓血管外科学会雑誌

A recent fatal accident related to the use of the pulmonary artery catheter (PAC) promoted us to conduct a questionnaire survey to assess the current use of the PAC and its complications during cardiac surgery. Methods : A 10-item questionnaire was distributed to all board-certified cardiovascular surgery centers in Japan. Five hundred thirty-two questionnaires were distributed and 325 (61.1%) were returned. Results : Seventy-two percents of hospitals used the PAC in more than 90% of cases, while only 17% used it less than 50% of the time. Indication of its use was not clearly determined in 52% of hospitals. Entrapment of the PAC was experienced in 28% of centers in the last 10 years, and its incidence was calculated as 0.07%. At a quarter of hospitals, checking for PAC to confirm absence of entrapment was not performed during the operation. Pulmonary artery rupture occurred at 22% of hospitals, and its incidence was 0.05%. Agreements on handling PAC to prevent cardiac injury or pulmonary artery rupture were not made in 24 and 56% of hospitals respectively. Conclusion : These data demonstrate that in many of the cardiac surgery centers in Japan, the PAC is still routinely used. Serious complications including catheter entrapment and pulmonary artery injury were encountered in a substantial number of patients. Development of guidelines for PAC during cardiac surgery to limit its use to patients with clear benefits and prevent related complications is warranted.

An accessory abductor digiti minimi as possible risk factor of the median and ulnar nerves compression / Músculo abductor digiti minimi accesorio como posible factor de riesgo de la compresión de los nervios mediano y ulnar

SUMMARY: During routine dissection of a left upper limb of a 68-year-old male human cadaver, an unusual muscle was observed originating from the radius and flexor retinaculum, and continued in the hypothenar region with the muscle belly of the abductor digiti minimi. We checked that it was an accessory abductor digiti minimi (ADM). Its muscular belly was in close relation to the median and ulnar nerves. We review the literature regarding such muscle variations and discuss the potential for compression of the median and ulnar nerves. Although the accessory ADM is usually asymptomatic and only rarely results in nerve compression, it should be taken into account by surgeons when establishing a differential diagnosis in the compression neuropathies of the median and ulnar nerves. An ultrasound scanning can help establish the differential diagnosis.

RESUMEN: Durante la disección de rutina de un miembro superior izquierdo de un cadáver humano masculino de 68 años, se observó un músculo inusual que se originaba en el radio y el retináculo flexor del carpo, y continuuaba en la región hipotenar con el vientre muscular del abductor digiti minimi manus. Verificamos que se trataba del músculo abductor digiti minimi accessorius (ADMA). Su vientre muscular se encontraba en estrecha relación con los nervios mediano y ulnar. Revisamos la literatura sobre variaciones musculares y discutimos la potencial compresión de los nervios mediano y ulnar. Aunque el ADMA suele ser asintomático y rara vez produce compresión nerviosa, los cirujanos deben tenerlo en cuenta al establecer un diagnóstico diferencial en las neuropatías de compresión de los nervios mediano y ulnar. Una ecografía puede ayudar a establecer el diagnóstico diferencial.

Formulation, Optimization And Characterization Of Nanostructured Lipid Carrier Of Nitrofurantoin

Nitrofurantoin is effective against many urinary tract pathogens. It acts as bacteriostatic and/or bactericidal by inhibiting DNA-RNA protein& cell wall synthesis. Nanostructured Lipid Carriers (NLCs) of NFT was prepared by Hot Homogenization Process. Glyceryl Monostearate and Miglyol 812 were heated at 80ºC temperature on hot plate. In the melted lipid, drug was added with continuous stirring at high speed homogenization. Formulation NLC12B has % Entrapment efficiency 89.1 ± 0.5, PDI 0.11 ± 0.01 and mean particle size 237 ± 7nm represents narrow particle size distribution. Spherical feature of NLCs with better uniformity without aggregation of Nitrofurantoin loaded NLC was confirmed by TEM. Moreover, efficient miscibility of drug in lipids was confirmed by the absence of intense and characteristic peak of NFT in XRPD. After 6 month storage at 2-8°C there was no significant changes in the PDI as well as mean particle size.

Prevalence and management of refractory meralgia paresthetica in lumbar spine surgery: 5 years of experience / Prevalência e manejo da meralgia parestésica refratária em cirurgia de coluna lombar: experiência de cinco anos / Prevalencia y manejo de la meralgia parestésica refractaria en cirugía de columna lumbar: experiencia de 5 años

ABSTRACT Objective The objective of our study was to report 5 years of experience in the recognition and management of refractory meralgia paresthetica (MP) in patients who had undergone posterior approach lumbar surgery. Methods Patients who were submitted to procedures in the lumbar spine from January 2010 to January 2015 in three different hospital centers in Belo Horizonte/MG were selected for an evaluation of the postoperative development of MP. A prospective observational comparative case series study. Level of evidence III. Evaluation of the following parameters: type of support for the patient, surgical time, body mass index. Results 367 posterior approach lumbar spine surgeries for degenerative pathologies of the lumbar spine were performed. MP was observed in 81 patients (22%). In 65 of those patients (80%), there was complete resolution of the symptoms with conservative management (local measures and medications for neuropathic pain) in less than two months. Twelve patients improved with a corticosteroid depot injection in the inguinal ligament and four patients required a surgical procedure in the third month. Pneumatic support was the least involved in the development of MP, as well as surgical time <1h and body mass index <25. Conclusion Refractory MP may occur in patients submitted to posterior approach lumbar spine surgeries. Management includes local measures, medications for neuropathic pain, and corticosteroid injection in the inguinal ligament. Decompression surgery is reserved for rare refractory cases. Level of evidence III; Prospective observational study with comparative case series.

RESUMO Objetivo O objetivo do presente estudo consiste em relatar a experiência de cinco anos no reconhecimento e manejo da meralgia parestésica (MP) refratária em pacientes submetidos a cirurgias lombares por via posterior. Métodos Pacientes submetidos a procedimentos na coluna lombar, no período de janeiro de 2010 a janeiro de 2015, em três diferentes centros hospitalares de Belo Horizonte/MG, foram selecionados para avaliação do desenvolvimento da MP pós-operatória. Estudo prospectivo observacional com série de casos comparativos. Nível III de evidência. Avaliação dos seguintes parâmetros: tipo de suporte para o paciente, tempo de cirurgia, índice de massa corporal. Resultados Foram feitas 367 cirurgias por via posterior da coluna lombar para patologias degenerativas da coluna lombar. A MP foi observada em 81 pacientes (22%). Em 65 pacientes (80%), houve resolução completa dos sintomas com manejo conservador (medidas locais e medicamentos para dor neuropática) em menos de dois meses. Doze pacientes melhoraram através de infiltração com corticoide de depósito e anestésico no local no ligamento inguinal e, em quatro pacientes houve necessidade de procedimento cirúrgico no terceiro mês. O suporte pneumático foi o menos envolvido no desenvolvimento da MP, assim como o tempo cirúrgico <1h e índice de massa corporal <25. Conclusão A MP refratária pode ocorrer em pacientes submetidos a cirurgias na coluna lombar por via posterior. O manejo inclui medidas locais, medicamentos para dor neuropática e infiltração com corticoide no ligamento inguinal. A cirurgia descompressiva está reservada para os raros casos refratários. Nível de evidência III; Estudo prospectivo observacional com série de casos comparativos.

RESUMEN Objetivo El objetivo del presente estudio consiste en relatar la experiencia de 5 años en el reconocimiento y manejo de la meralgia parestésica (MP) refractaria en pacientes sometidos a cirugías lumbares por vía posterior. Métodos Pacientes sometidos a procedimientos en la columna lumbar, en el período de enero de 2010 a enero de 2015, en tres diferentes centros hospitalarios de Belo Horizonte/MG, fueron seleccionados para evaluación del desarrollo de la MP postoperatoria. Estudio prospectivo observacional con serie de casos comparativos. Nivel III de evidencia. Evaluación de los siguientes parámetros: tipo de soporte para el paciente, tiempo de cirugía, índice de masa corporal. Resultados Se realizaron 367 cirugías por vía posterior de la columna lumbar para patologías degenerativas de la columna lumbar. La MP fue observada en 81 pacientes (22%). En 65 pacientes (80%) hubo resolución completa de los síntomas con manejo conservador (medidas locales y medicamentos para el dolor neuropático) en menos de 2 meses. Doce pacientes mejoraron a través de infiltración de corticoide de depósito y anestésico en el local en el ligamento inguinal y, en cuatro pacientes, hubo necesidad de procedimiento quirúrgico en el tercer mes. El soporte neumático fue el menos involucrado en el desarrollo de la MP, así como el tiempo quirúrgico <1h e índice de masa corporal <25. Conclusión La MP refractaria puede ocurrir en pacientes sometidos a cirugías en la columna lumbar por vía posterior. El manejo incluye medidas locales, medicamentos para el dolor neuropático e infiltración con corticoide en el ligamento inguinal. La cirugía descompresiva está reservada para los raros casos refractarios. Nivel de evidencia III; Estudio prospectivo observacional con serie de casos comparativos.

Frequency of Complete Absence of Suprascapular Notch in Dry Scapulae - An Osteological Study with Clinical Significance

Suprascapular notch is a depression located in the superior border of the scapula near its lateral part, close to the root of the coracoid process. It is bridged by the superior transverse scapular ligament & serves as a path for the suprascapular nerve. The notch is commonly seen in all the scapulae with variable morphology. Sometimes, it is associated with ossified transverse scapular ligament which plays an important role for the suprascapular neuropathies which has been suggested in many previous literatures. But, its absence can also be a reason for nerve entrapment which has been mentioned less frequently. The purpose of this study was to find out the incidence of completely absent suprascapular notch among dry scapulae of north India, especially Gurugram region along with a morphometric evaluation of superior border of scapular where the notch is situated.METHODSOne hundred & ten adult dry scapulae of unknown sex from the osteology museum of SGT Medical College, Gurugram, were obtained for evaluation of absence of suprascapular notch in the superior border of the scapulae near the root of the coracoid process by subjective evaluation (visual inspection). We have also done a morphometric evaluation (length) of the superior border of all the scapulae irrespective of the suprascapular notch. Our observations were compared with other osteological studies performed on other population groups.RESULTSOf the 110 scapulae studied, 43 belonged to right side & 67 scapulae of left side. By visual inspection, 13 scapulae (11.8%) were devoid of suprascapular notch on the upper border & rest 88 scapulae (88.81%) had different variety of suprascapular notch. Among the 13 scapulae without suprascapular notch, 8 scapulae (61.5%) were of right side and 5 scapulae (38.46%) were of left sided bone. Apart from this, the average length of the superior border of the scapulae was 42.73 mm.CONCLUSIONSIncidence of completely absent suprascapular notch in our study is 11.8% which will act as a reference point among Gurugram population in north India. Clinicians should keep in mind about complete absence of suprascapular notch which can be a probable reason for the suprascapular nerve entrapment.

Conveyor Belt Entrapment Trauma in Children: An Unreported Menace

A retrospective study was conducted including all the childrenwho sustained motorized machine belt entrapment injuries. Sixchildren included in study had mean (SD) Glosgow coma scaleand pediatric trauma score of 5.7 (3.54) and 3.2 (1.21),respectively. Overall mortality and paraplegia rate were 33.3%each. Awareness and legislation both are important to curb thismenace

The Suprascapular Notch: Its Morphology Morphometry And Clinical Significance

Introduction: The Scapula is a large, flat, triangular bone which lies on the posterolateral aspect of the chestwall. The Suprascapular notch is a depression on the superior border of the scapula which gives passage toSuprascapular nerve. Anatomical variations of the shape and size of notch is useful as it is the common site ofSuprascapular nerve entrapment syndrome.Materials and Methods: The present study was carried out on 60 adult dry human Scapulae. Different shapes ofSuprascapular notch was observed, then vertical and transverse dimensions of the notch were measured.Results and Conclusion: Based on Rengachary classification, type III notch was found to be most common.Suprascapular foramen was observed in 5 Scapulae. The mean vertical and transverse diameters were measuredas 6.43mm and 9.81mm respectively. The study of morphology and morphometry of Suprascapular notch helpsto correlate Suprascapular nerve entrapment with specific type of notch.

Effectiveness of lower extremity Dellon triple nerve decompression in treatment of early-stage diabetic Charcot foot / 中国修复重建外科杂志

Objective: To study the effectivenss of lower extremity Dellon triple nerve decompression in the treatment of early-stage diabetic Charcot foot. Methods: The clinical data of 24 patients with Eichenholtz stage 0-1 diabetic Charcot foot who were admitted between September 2017 and February 2019 were retrospectively analyzed. Among them, 14 cases were treated with lower extremity Dellon triple nerve decompression (treatment group), and 10 cases were treated with conservative treatment such as immobilization the affected limbs and nutritional nerve drugs (control group). There was no significant difference between the two groups ( P>0.05) in gender, age, diabetes duration, diabetic foot duration, Eichenholtz stage, and the blood glucose level, bone mineral density (T value), nerve conduction velocity, and two-point discrimination before treatment. Before treatment and at 6 months after treatment, bone mineral density (T value) was measured by dual energy X-ray absorptiometry to evaluate the improvement of osteoporosis. The electromyogram of the lower limbs was used to detect the conduction velocity of the common peroneal nerve, deep peroneal nerve, and tibial nerve, and to evaluate the recovery of nerve function. The two-point discrimination in plantar region was used to evaluate the recovery of skin sensation. Results: Both groups were followed up 6-12 months, with an average of 6.5 months. In the treatment group, 3 patients showed numbness around the incisions, all recovered after 12 months, without affecting the prognosis; all the incisions healed by first intention, and there was no complication such as incision infection, nonunion, or vascular and nerve injury. At 6 months after treatment, there was no significant difference in nerve conduction velocity, bone mineral density (T value), and two-point discrimination when compared with the values before treatment ( P>0.05) in the control group; but the above indicators in the treatment group were significantly improved when compared with preoperative ones, and were all significantly better than those in control group ( P<0.05). Conclusion: Lower extremity Dellon triple nerve decompression can improve the symptoms of Eichenholtz stage 0-1 diabetes Charcot foot, and has the advantages of less trauma, faster recovery, and fewer complications.

Preparation of glabridin ethosomes and their bioactivity evaluation / 中草药

Objective: To compare the effects of softeners including ethanol, propylene glycol and mixed alcohol (ethanol-propylene glycol 2:8) on the preparation of glabridin ethosomes (GLA-ES), and provide the selection basis of the softeners for studying the ethosomes of insoluble drugs. Methods: GLA-ES were prepared by injection-ultrasonic binding method with ethanol, propylene glycol and mixed alcohol (ethanol-propylene glycol, 2:8) as softeners. The morphology, size, Zeta potential, entrapment efficiency, stability, and in vitro drug release of GLA-ES were investigated. Tyrosinase activity on melanoma B16-OVA cells were detected to evaluate the inhibition of GLA-ES on the synthesis of melanin, the experiment of potassium ferricyanide reducing power was performed to evaluate the antioxidant effect of GLA-ES, and human epidermal HaCaT cells and rat skin were used for preliminary safety evaluation. Results: GLA-ES were yellow translucent liquid, containing vesicular phospholipid bilayer structure, the average particle size of GLA-Et-ES, GLA-PG-ES and GLA-MA-ES were (34.24 ± 0.29), (62.31 ± 1.66) and (41.20 ± 1.13) nm, respectively; The Zeta potential were (-41.0 ± 1.8), (-32.9 ± 0.2) and (-35.8 ± 1.6) mV, the entrapment efficiency were (91.47 ± 2.39)%, (87.33 ± 1.31)% and (91.39 ± 3.59)%, respectively, which had good stability of storage at 4 ℃ for 20 d, in vitro drug release behaviors of GLA-ES fitted Higuchi equation, implying their sustained release properties. Compared with the glabridin suspension, the inhibitory effects of GLA-Et-ES, GLA-PG-ES and GLA-MA-ES on tyrosinase activity in melanoma B16-OVA cells were increased by 38.07%, 19.58% and 40.42%, respectively. The results of potassium ferricyanide reducing power also showed that GLA-ES had a stronger in vitro antioxidant effect than the glabridin suspension; GLA-ES were nearly nontoxic on normal cells and had no irritation to rat skin. Conclusion: GLA-ES can be obtained by hree kinds of softeners, which can inhibit the synthesis of melanin and enhance the antioxidant effect with good safety. The present research will provide the basis for further developing skin-whitening cosmetics or pharmaceutical external preparation. For the insoluble drugs such as glabridin, when mixed alcohol (ethanol-propylene glycol) was selected as the softener to prepare ethosome, it exhibited better encapsulation efficiency and stability than that of ethanol or propylene glycol as the softener alone.

Two Cases of Popliteal Artery Entrapment Syndrome / 日本心臓血管外科学会雑誌

Popliteal artery entrapment syndrome (PAES) is a rare cause of intermittent claudication. Optimal strategies and management have been debated. We report two cases of PAES that were treated with respective different procedures. Case 1 : A 53-year-old male with intermittent claudication was referred to our department with PAES with a decrease in the ankle brachial index (ABI) with plantar flexion. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) showed medial deviation and compression of the popliteal artery by the medial head of the gastrocnemius muscle. The patient received excision of the medial head of the gastrocnemius muscle and thrombectomy of the popliteal artery. The diagnosis was confirmed as PAES type 2 during the procedure. Case 2 : A 37-year-old male presenting intermittent claudication and declining ABI in his left lower extremity was diagnosed with PAES by contrast CT. MRI and CT indicated that a fibrous band was compressing the popliteal artery. The findings of the imaging studies were confirmed during the subsequent surgical procedure and it was diagnosed as PAES type 4. In addition to removal of the band, popliteal artery interposition using a saphenous vein graft was performed due to severe stenosis with intimal hyperplasia. Pathological findings of the excised artery showed intimal hyperplasia and degeneration of elastic fibers in the media due to chronic compression. Although a large volume of retrospective data exists on PAES, recommendation of a particular operative procedure has not yet been derived. Thus, the treatment for PAES should be individually determined based on etiology and status of affected vessels.

Carpal Tunnel Syndrome in Pregnancy : Is There Really Oedema in the Carpal Tunnel?

@#Compression of the median nerve in pregnancy is thought to be due to fluid retention within the carpal tunnel space. We aim to discover the cause of carpal tunnel syndrome (CTS) in pregnancy using high resonance ultrasonography. Methods: This is a cross-sectional study where obstetric patients were screened for CTS and subjected to a non invasive ultrasonic imaging. Results: A total of 63 patients were seen with 25 diagnosed to have CTS (39.7%) and 38 patients had none (60.3%) based on a screening tool. Age ranged from 20-42 years old with the highest range in the 28-30 year old group (34.9%). In patients with CTS, the cross sectional area of the median nerve inside the tunnel was a mean of 0.908 cm² ie larger, while non-CTS patients had a mean of 0.797 cm² inside the tunnel. The transverse carpal ligament (TCL) measured a mean of 0.0988 cm in the CTS group (ie thinner) and 0.1058 cm in the non-CTS group. Median nerve mobility at equal to or less than one tendon width was 80% in pregnant women with CTS and 92.1% for those without. No fluid was present within the carpal tunnel of all patients. The results were statistically not significant. Conclusion: Ultrasonographic evidence in pregnant women with CTS shows a larger median nerve, a more mobile median nerve and a less thick transverse carpal ligament. There is absence of fluid retention and synovitis ruling out extrinsic compression of the median nerve as cause of CTS in pregnancy.