Clinical rabies: is cure possible.

Rabies is a fatal disease in humans and till date survivors of the disease after the clinical onset of the illness are rare. The approach to management of rabies is usually palliative. In rare cases of paralytic rabies a trial for cure has been tried. No single therapeutic agent is likely to be effective, but a combination of specific therapies could be considered, including rabies vaccine, rabies immunoglobulin, monoclonal antibodies, ribavirin, interferon alpha, ketamine etc. the only reported cases in literature were with rare success of the Milwaukee protocol. This is the case report of a 45 year old male who presented with clinical rabies and was started on the trial. Has the treatment had any benefit is to be debated and further options discussed.

Variation in brachial plexus formation, branching pattern and relation with major vessels.

Background: Anatomical variations in the formation, branching pattern and relations of the brachial plexus have been described in humans by many authors; however these have not been extensively catalogued. The aim of the study was to describe variations in brachial plexus formation, branching pattern and relation with major vessels. Methods: This study included thorough dissection of 60 brachial plexuses which belonged to 30 cadavers (male: female ratio = 28:02 ) with age range of 20-60 years, obtained from the Department of Anatomy, College of Medical Sciences (CMS-TH), following standard guidelines. Results: Out of 60 limbs dissected in present study, the variation in formation was found in 20 limbs (33.3%), out of which 12 limbs (20%) had variations in the trunk and 8 limbs (13.3%) had variations in the cord, remaining 40 limbs (66.6%) were normal in the formation of brachial plexus. Normal branching pattern of the posterior cord was encountered in 52 (86.67%) limbs, the remaining 8 (13.33%) being variants in one form or the other. The upper subscapular nerve, the thoracodorsal nerve, the lower subscapular nerve and the axillary nerve were found to arise normally in 91.66%, 96.66%, 96.66% and 98.33% of the limbs respectively. Conclusion: The present study carried out on adult human cadavers revealed some rare variations in the formation, branching pattern and relations of the brachial plexus. These variations are of clinical significance for the surgeons, radiologists and the anesthesiologists.