Unusual topography of posterior antebrachial musculature in the first osseofibrous compartment of wrist: clinicomorphological appraisal / Topografía inusual de la musculatura antebraquial posterior en el primer compartimento osteofibroso de la muñeca: valoración clínico-morfológica

Anatomical variations of abductor pollicis longus and extensor pollicis brevis are important in clinical assessment of diseased and traumatized hand. The present case reports an unusual fusion of muscle bellies of abductor pollicis longus and extensor pollicis brevis with two separate tendons of insertion, the medial tendon inserted into the base of first metacarpal and the lateral tendon into the abductor pollicis brevis muscle. Knowledge of such anatomical variations is of utmost importance in the management of De Quervain's disease and reconstructive surgeries of hand.

Las variaciones anatómicas de los músculos abductor largo del pulgar y extensor corto del pulgar son importantes en la evaluación clínica de la mano enferma y traumatizada. El presente caso informa una inusual fusión de los vientres musculares de los Mm. abductor largo del pulgar y extensor corto del pulgar con dos tendones de inserción separados, el tendón medial se insertó en la base del primer metacarpiano y el tendón lateral en el músculo abductor corto del pulgar. El conocimiento de estas variaciones anatómicas es de importancia en el manejo de la enfermedad de De Quervain y cirugía reconstructiva de la mano.

Persistent nodular contact dermatitis to gold: Case report of two cases.

Metallic gold has long been regarded as a relatively safe and inert material when in contact with the skin and mucosal membranes, with only sporadic reports of allergic contact dermatitis. We report two cases, where persistent nodules developed at sites of gold piercing with gold jewelry with positive patch test reactions to gold.

Giant granular cell tumor of the vulva.

A 55-year-old lady presented with a large skin colored growth on her vulva since the age of 15 years, which gradually increased to the present state, with the development of a new lesion on her left thigh. There were no systemic symptoms. Biopsy followed by immunohistochemistry showed features consistent with a granular cell tumor.

Unilateral quadripartite composition of pectoral major muscle: anatomical description and clinical implications / Composición unilateral cuadripartita del músculo pectoral mayor: descripción anatómica e implicancias clínicas

A unilateral anomalous disposition of the muscular slips of pectoralis major was observed in an adult male cadaver during routine gross anatomy teaching session. The pectoralis major muscle displayed unusual configuration and comprised of four parts delineated by three intramuscular clefts. Further, the sternocostal part was found to divide into two fasciculi. The origin and insertion of pectoralis major muscle was as usual and unremarkable. Interestingly, the innervation of the muscle was observed to bear an important variation. The clavicular and sternocostal slips of pectoralis major muscle received a direct branch from the lateral cord of brachial plexus in addition to its usual innervation from the lateral and medial pectoral nerves. The multiplicity of innervation of pectoralis major as encountered in the present study would presumably augment its suitability for its use in reconstructive procedures. An additional anomalous attachment of the pectoralis minor muscle was also observed emanating from the second rib, apart from the usual third, fourth and fifth ribs. These variants of the pectoral muscles may also have implications in biomechanical studies, as they may alter the kinematics.

Una disposición anómala unilateral de los vientres musculares del músculo pectoral mayor se observó en un cadáver adulto de sexo masculino durante una clase de rutina de anatomía. El músculo pectoral mayor mostró una configuración inusual y presentaba cuatro partes delimitadas por tres depresiones intramusculares. Además, la parte esternocostal se encontraba dividdida en dos fascículos. El origen y la inserción del músculo pectoral mayor era normal. Curiosamente, la inervación de los músculos, presentaba una importante variación anatómica. Los fascículos clavicular y esternocostal del músculo pectoral mayor recibieron una rama directa del fascículo lateral del plexo braquial, además de su inervación normal de los nervios pectoral lateral y medial. La múltiple inervación del músculo pectoral mayor como se encuentró en el presente estudio, probablemente, haga aumentar su idoneidad para el uso en procedimientos reconstructivos. También se observó un fascículo adjunto anómalo adicional del músculo pectoral menor, que se originaba de la segunda costilla, además de su origen en la tercera, cuarta y quinta costillas. Estas variaciones de los músculos pectorales también puede tener implicancias en estudios biomecánicos, ya que probablemente alteran la cinemática.

Nasal NK/T cell lymphoma presenting as a lethal midline granuloma.

Nasal NK/T cell lymphomas are aggressive, locally destructive, midfacial, necrotizing lesions. The nonspecific clinical symptoms constitute a major stumbling block in the early diagnosis and management of these lymphomas. We report here a case of probable nasal NK/T cell lymphoma in an apparently healthy male that progressed rapidly in a short span of time and was managed subsequently with chemotherapy and external beam irradiation with which the lesion regressed.

Clinical profile of forefoot eczema: a study of 42 cases.

BACKGROUND: Forefoot eczema (FE) is characterized by dry fissured dermatitis of the plantar surface of the feet. AIM: To study the clinical profile of FE and the possible etiological factors. METHODS: Forty-two patients with FE were included in the study. A detailed history was recorded and examination done. Fungal scrapings and patch test with Indian Standard Series (ISS) were performed in all patients. RESULTS: The most common site affected was the plantar surface of the great toe in 16 (38.09%) patients. Hand involvement, with fissuring and soreness of the fingertips and palm, was seen in four patients (9.5%). Seven patients (16.6%) had a personal history of atopy whereas family history of atopy was present in six (14.2%). Seven patients (16.6%) reported aggravation of itching with plastic, rubber or leather footwear, and 13 (30.9%), with detergents and prolonged contact with water. Negative fungal scrapings in all patients ruled out a dermatophyte infection. Patch testing with ISS was performed in 19 patients and was positive in five. CONCLUSIONS: FE is a distinctive dermatosis of the second and third decade, predominantly in females, with a multifactorial etiology, possible factors being chronic irritation, atopy, footwear and seasonal influence.

Lichen amyloidosus: a study of clinical, histopathologic and immunofluorescence findings in 30 cases.

BACKGROUND: Lichen amyloidosus (LA) is a primary localized cutaneous amyloidosis characterized clinically by discrete hyperkeratotic hyperpigmented papules and histologically by deposition of amyloid material in previously normal skin without any evidence of visceral involvement. AIMS AND OBJECTIVES: The aim of this work was to study the etiology, clinical features, histopathology and direct immunofluorescence findings in LA. METHODS: A prospective study of 30 patients with clinical, histological and immunofluorescence findings suggestive of LA was undertaken. After a detailed history and clinical examination, two punch biopsies for histopathology and immunofluorescence were taken. RESULTS: Of the 30 patients, 19 (63.3%) were males and 11 (36.7%) were females with duration of LA ranging from 6-20 months. Pruritus was the presenting symptom in 27 (90%) patients. Shin was involved in 26 (86.7%) followed by arms in three (10%) and back in one (3.3%). Seventeen patients (56%) had used scrubs for more than 2 years. Histopathology, direct immunofluorescence and Congo red staining detected amyloid in all cases. CONCLUSIONS: LA commonly presents over the shins as pruritic discrete hyperpigmented papules. Familial predisposition and friction may have a pathogenic role. Histopathological examination is very useful in the detection of amyloid which may be supplemented with direct immunofluorescence and Congo red staining.

Extensive larva migrans.

Larva migrans is characterized by tortuous migratory lesions of the skin caused by larvae of nematodes. A 26-year-old fisherman presented to us with complaints of an itchy eruption on his back and arms of two months' duration. Clinical examination revealed multiple wavy serpentine tracts and fork like lesions with a raised absolute eosinophil count of 3800 cells/cmm. Biopsy was inconclusive. This case is reported to highlight the extensive involvement by larva migrans.