Comparative study of soleus H-reflex in normal humans and in patients with neuropathies

Background: The H-reflex derived its name from Hoffman. Hoffmann reflex is an electrically induced reflex analogous to the mechanically induced spinal stretch reflex. This measurement can be used to assess the response of the nervous system to various neurological conditions, musculoskeletal injuries, and application of therapeutic modalities, pain, exercise training, and performance of motor tasks. This simple and reproducible physiological response was studied to evaluate conduction along the course of the whole “final common pathway” from the moto neuron to the terminal axon as well as to gain some information regarding the function of large diameter group la afferent fibers supplying the muscle spindle. Aims and Objectives: The aim of the study was to compare the H-reflex latency between the normal person and in neuropathic patients. The study aimed to see whether there is any difference in H-reflex latency in the right leg of normal person and in neuropathic patients. The study aimed to see whether there is any difference in H-reflex latency in the left leg of normal person and in neuropathic patients. Materials and Methods: The study was conducted among 25 normal subjects and 25 neuropathic patients between 20 and 70 years of age from Nootan Medical College and Research Centre, Visnagar. The normal subjects were evaluated clinically to find their normal condition. The neuropathic patients which are included in study are of diabetic neuropathy, plexopathy, radiculopathy, vitamin deficiency, and Guillain Barre Syndrome. The patients who had bilateral neuropathy were included in the study. The study was conducted using mainly stimulator circuit, stimulating and recording electrodes, preamplifier, and oscilloscope. The software used for this experiment was RMS EMG EPMK II, one of the latest software with facilities for nerve conduction velocity, electromyography, F-wave, and H-reflex recording. Results: Out of the 50 participants, 25 participants who were suffering with any kind of neuropathy evaluated for their H-reflex latency in both leg. Patients with neuropathy showed higher latency in the right leg compared to the 25 participants in the control group in the right leg demonstrated significantly higher latency in the group with neuropathy. The 25 participants who were suffering with any kind of neuropathy evaluated for their H-reflex latency left leg compared to the 25 participants in the control group left leg demonstrated significantly higher latency in the group with neuropathy. Conclusion: The results show that there is an increase in the H-reflex latency in neuropathy patients as compared to normal subjects but it can be not used as a specific test for diagnosis of neuropathies, because the H-reflex latency may also change in normal subjects as the age of the persons is increases or the height of the persons increases but H-reflex latency can be used for the diagnosis of the proximal nerve root injuries as it mainly investigates the proximal nerve reflex arc.

Abnormal origin of right subclavian artery – A cadaveric study.

Background: During early embryonic life, the aortic arch undergoes complex development and normally results in the formation of a left aortic arch from which three arteries arise: (1) the brachiocephalic artery, which divides into the right common carotid and right subclavian arteries, (2) the left common carotid artery and (3) the left subclavian artery. In the present study we found an aberrant right subclavian artery arising from the arch of aorta distal to the left common carotid artery. Aims & Objective: Abnormalities of branches of arch of aorta are not uncommon and they have been identified more frequently with increasing use of imaging studies. However, the clinician should be aware of the wide range of anomalies that occur in the arch & the great vessels. This could help in adequately managing these variations in emergency approaches to the arch & the great vessels when imaging studies are not available. Our aim is to report the occurrence of the abnormal origin of right subclavian artery in a sample of western Indian population. Material and Methods: Present study was conducted on embalmed cadavers in Anatomy Department at various medical colleges in Gujarat. Branches of arch of aorta were dissected & observed for any variation. Results: A total of 70 cadavers were dissected. In one cadaver we found abnormal origin of right subclavian artery from the arch of aorta. The anomalous artery was passing behind the oesophagus. (1.43%, n = 70) Conclusion: An aberrant right subclavian artery is a rare vascular anomaly & it is also an unusual cause of problems with the passage of solid food through the oesophagus. Recently it has been suggested that it occurs more frequently in patients with Down syndrome. Knowledge of this anomaly is important while evaluating feeding difficulties in patients with Down syndrome as well as in preventing vascular complications in patients with aberrant right subclavian artery.

A study on variation in the insertion of Coracobrachialis muscle and its clinical importance.

Background: The coracobrachialis muscle morphologically represents the adductor group of muscles in the arm but such function became insignificant in man during the process of evolution. It is more important morphologically than functionally & it is known for its morphological variations. Aims & Objective: Variations in the structures of the human body are of importance to clinicians while performing any surgery or procedure or in the diagnosis of certain clinical conditions. Our aim is to report the occurrence of variation in insertion of coracobrachialis muscle & to observe the relationship of its abnormal slip with the median nerve & brachial artery. Material and Methods: Present study was conducted on embalmed cadavers at various medical colleges in Gujarat. The coracobrachialis muscle was dissected in both the upper extremities & observed for any abnormal slip or for any variation in insertion. Results: A total of 120 upper limbs of 60 cadavers were dissected. Variation at insertion was found in four cadavers as an abnormal slip to medial epicondyle of humerus & to the deep fascia on the medial aspect of arm. [6.66 % , n = 60] Conclusion: Anomalous insertion of coracobrachialis muscle may lead to compression of median nerve & brachial artery. The knowledge of such variations are of importance for surgeons, orthopaedicians, neurologists, radiologists & physiotherapists while dealing with injuries or operations around elbow joint. This muscle can also be used in muscle transplants.

Morphometric analysis and sex determination from clavicles in Gujarati population.

Background and Objectives : To determine sex from unknown skeletal remains is vital. Various methods to do this on different bones of human skeleton have been extensively studied. In general male bones are heavier larger and muscular markings are more prominently seen as compared to female bones. The objective of this study was to find out comparative differences between the right and left clavicles from certain metrical parameters and to enable assessment of sex from unknown clavicles. Methods: The study was conducted on 213 adult clavicles, out of which 96 were of the right side and 117 were of the left. The maximum length of clavicles in mm was taken and demarking points were established by adding and subtracting 3×SD from means. Results: The mean length of right clavicle was 142.28 mm ± 11.40 mm SD and that of left clavicle was 145.14 mm ± 11.87 mm SD. It has been observed that left clavicle is longer than right clavicle by 2.82mm. Depending upon length of clavicle the sex can be decided in 3.13% male and 2.08% female in right clavicles and 1.71% male and 1.71% female in left clavicles. Conclusion: The left clavicle was longer compared to right clavicle. Demarking points give 99.75% accurate data, measured by adding & subtracting 3×SD from means. Demarking points for length of clavicles were >176.48 mm for male & <108.08 mm for female on right side and >180.75mm for male & <109.53 mm for female on left side for this study. This study is useful for medico legal and anthropological examination of bones and for academic studies in anatomy.

Higher bifurcation of brachial artery with superficial course of radial artery in forearm: A study report.

Background: Normally brachial artery divides into its terminal branches namely radial and ulnar arteries at the neck of the radius in the cubital fossa and these are the main arteries responsible for the irrigation of the forearm. In the present study we found higher division of brachial artery into radial and ulnar arteries with superficial course of radial artery unilaterally during routine dissection for MBBS student. Accurate information regarding these variations is important during vascular and re-constructive surgery and also in evaluation of angiographic images. Aims & Objective: The altered anatomy of the blood vessels may make them more vulnerable to trauma and to haemorrhage but at the same time more accessible for cannulation. Our aim is to report the occurrence of the higher division of brachial artery with superficial course of radial artery in a sample of western Indian population. Material and Methods: A prospective evaluation was conducted on cadavers at various Medical Colleges, in Gujarat. The upper limbs of cadavers were dissected and observed for any variation in the course of brachial artery and its terminal branches radial and ulnar arteries. Results: A total of 96 arms of 48 subjects were studied. In three upper limbs we found higher division of brachial artery with superficial course of radial artery. The variant was present unilaterally in left upper limb of three males (6.25%, n = 48). Conclusion: Anomalies in origin and course of principal arteries have practical importance for orthopaedicians, radiologists and vascular surgeons. Awareness of incidence of this variation is necessary to avoid complication during pre-operative procedure or surgeries in the upper limb.