Bilateral variation in the branching pattern of the subclavian artery: an unusual finding with clinical implications / Variação bilateral no padrão de ramificação da artéria subclávia: um achado incomum com implicações clínicas

Abstract The subclavian artery is a significant branch of the aortic arch. We present a rare case of a bilateral variation in the branching pattern of the subclavian artery, observed in an adult male cadaver aged 70 years. On both the sides of the neck, all the branches of the subclavian artery took their origin from its first part. There was a rare occurrence of a cervicodorsoscapular trunk, which gave rise to superficial cervical, suprascapular, and dorsal scapular arteries. The same branching pattern was observed on the left side of the neck, with the presence of another cervicodorsoscapular trunk. Thyrocervical trunk and transverse cervical artery were both absent from the cervical region bilaterally. The inferior thyroid artery was a direct branch from the subclavian artery. Knowledge regarding variations of the subclavian artery is very important as lateral cervical region arteries are important for flap harvesting in plastic and reconstruction surgery. Preoperative radiologic evaluation of pedicles might help in choosing the optimal flap design, prevent ischemic complications, and help to improve overall treatment outcomes.

Resumo A artéria subclávia é um ramo significativo do arco da aorta. Apresentamos um caso raro de variação bilateral do padrão de ramificação da artéria subclávia, observada em um cadáver adulto do sexo masculino de 70 anos. Em ambos os lados do pescoço, todos os ramos da artéria subclávia originavam-se de sua primeira parte. Houve rara ocorrência de tronco escapular cervical dorsal, que deu origem às artérias cervical superficial, supraescapular e escapular dorsal. O mesmo padrão de ramificação foi observado no lado esquerdo do pescoço, com a presença de tronco escapular cervical dorsal. O tronco tireocervical e a artéria cervical transversa estavam ausentes em ambas as regiões cervicais direita e esquerda. A artéria tireóidea inferior consistia em um ramo direto da artéria subclávia. O conhecimento das variações da artéria subclávia é fundamental, pois as artérias da região cervical lateral são importantes para a obtenção de retalhos em cirurgias plásticas e reconstrutivas. A avaliação radiológica pré-operatória dos pedículos pode ajudar na escolha do desenho ideal do retalho, prevenir complicações isquêmicas e ajudar a melhorar o resultado geral do tratamento.

Caesalpinia bonduc Linn Extracts Exhibit Hepatoprotective Effect on HepG2 Cells against Paracetamol by Up-regulating Glutathione Related Genes

Background: Caesalpinia bonduc (CB) is said to ownvarious pharmacological and therapeutic applicationagainst a number of diseases. It is used widely in folkmedicine to treat liver diseases. In the present study,we have made a sincere effort to evaluate thehepatoprotective activity of CB leaf extracts againstParacetamol (PCM) induced toxicity and theirmechanism of hepatoprotection in the humanHepatocarcinoma cells (HepG2 cells) therebyproviding scientific evidence for the same. Materialand Methods:The hepatoprotective activity of CB wasassessed in-vitro by the estimation of glutathione(GSH) and Malondialdehyde (MDA), anti-apoptoticassay/Annexin V and the expressions of genes such asGlutathione Reductase (GS-R) and GlutamateCysteine Ligase, Catalytic (GCLC). Results: Theobtained results suggest that the aqueous extract of CBpossess significant hepatoprotective activity. Thisactivity may be due to the possible antioxidantproperty and the free radical scavenging ability of theextracts, which might clear the toxic metabolites ofPCM. Conclusion: The present study suggests that theaqueous extract of CB have potential hepatoprotectiveactivity, which may prevent the lipid peroxidation ofthe cell membrane by its antioxidant properties.

Effect of Cissus quadrangularis Linn on skeletal growth in the neonates of diabetic rats.

Background: Infants of the diabetic mother are known to have reduced bone mineral content and hypocalcemia. Earlier, it has been shown that petroleum ether extract of Cissus quadrangularis (PECQ) can enhance the fetal skeletal ossification in normal rats. The present study was designed to evaluate the effect of PECQ on skeletal growth in the neonatal rats of streptozotocin-induced diabetic rats. Methods: After confirmation of diabetes, the diabetic and non-diabetic female Wistar rats were kept for mating with healthy male rats. After positive vaginal smear test, the pregnant rats were divided into three groups; the normal (non-diabetic) control (NC), diabetic control (DC), and diabetic+CQ (D+CQ) groups. The rats in the D+CQ group were given PECQ (500 mg/kg B.Wt), whereas animals in NC and DC groups were given 0.5% carboxy methyl cellulose, throughout the gestational period. Femur from the 1 week old neonatal rats from each group was collected randomly and subjected to histological analysis. Results: Thickness of trabecular bone and periosteum was significantly reduced in the neonates of DC rats compared with the neonates of NC group. Pretreatment with PECQ significantly improved the thickness of trabecular bone and periosteum compared with neonatal rats of DC group. No significant differences were observed in the medullary cavity width of femur between the groups. Conclusion: Data from the present study suggest that the PECQ can effectively attenuate the diabetes-induced reduction in the early skeletal growth. However, further research is warranted to evaluate the exact mechanism of action of phytochemical constituents of PECQ that can cross the placental barrier.

Protective effect of Cissus quadrangularisLinn. on diabetes induced delayed fetal skeletal ossification.

Background: Delayed fetal skeletal ossification is one of the known complications of maternal diabetes. Objective: The present study was designed to evaluate the protective role of petroleum ether extract of Cissus quadrangularis (PECQ) on diabetes‑induced delayed fetal skeletal ossification. Materials and Methods: Female Wistar rats were rendered diabetic with streptozotocin (STZ, 40 mg/kg, intraperitonial) before mating. After confirmation of pregnancy, the pregnant rats were divided into three groups: normal control group, diabetic control group, and diabetic + CQ group. The diabetic + CQ group pregnant rats were treated with PECQ (500 mg/kg body weight) throughout their gestation period. Immediately after delivery, pups were collected from all three groups and processed for alizarin red S–alcian blue staining in order to examine the pattern of skeletal ossification. Results: Fewer ossification centers and decreased extent of ossification of forelimb and hindlimb bones were observed in the neonatal pups of diabetic control group as compared to those in the normal control group. PECQ pretreatment significantly restored the ossification centers and improved the extent of ossification of forelimb and hindlimb bones in the neonatal pups of diabetic + CQ group as compared to those in the diabetic control group. Conclusions: The results suggested that PECQ treatment is effective against diabetes‑induced delayed fetal skeletal ossification. However, further studies on the isolation and characterization of active constituents of PECQ, which can cross the placental barrier and are responsible for the bone anabolic activity are warranted.

Unusual third head of the sternocleidomastoid muscle from the investing layer of cervical fascia / Inusual tercera cabeza del músculo esternocleidomastoideo desde la lámina superficial de la fascia cervical

The abnormal origin, presence of additional head and layered arrangement of fibers are the reported variations of sternocleidomastoid muscle in the past. In the present case we report a rare unusual origin of third head of the sternocleidomastoid muscle in a 60 year-old male cadaver. This additional head originated from the investing layer of cervical fascia in the roof of the subclavian triangle close to the clavicle and traversed obliquely upward, forward and fused with clavicular head. The insertion and nerve supply of the muscle was found to be normal...

El origen anormal, presencia de una cabeza adicional y disposición en capas de fibras son las variaciones reportadas del músculo esternocleidomastoideo. En el presente estudio, se presenta un origen poco habitual de la tercera cabeza del músculo esternocleidomastoideo en un cadáver de sexo masculino de 60 años. La cabeza supernumeraria se originaba en la lámina superficial de la fascia cervical en el techo del triángulo subclavio próximo de la clavícula y cruzaba oblicuamente hacia arriba y adelante para fusionarse con la cabeza clavicular. La inserción e inervación del músculo eran normales...

Communication of the anterior branch of the great auricular nerve with the cervical branch of facial nerve and its variant nerve endings deep in the parotid gland / Comunicación del ramo anterior del nervio auricular mayor con el ramo cervical del nervio facial y sus terminaciones nerviosas profundas variantes en la glándula parótida

The communications between the branches of cervical plexus and cervical branch of facial nerve are common and are well known. However, this communication usually occurs between the transverse cervical nerve and cervical branch of facial nerve. During routine dissection classes for the Medical undergraduate students, we came across an anatomical variant of anterior division of great auricular nerve. This variation was found in a 60-year-old male cadaver of South Indian origin and it was unilateral. The great auricular nerve arose from the loop of ventral rami of C2 and C3 spinal nerves and divided into anterior and posterior branches. The anterior branch ran obliquely upwards and forwards on the surface of the sternocleidomastoid muscle along with the external jugular vein towards the apex of parotid gland and divided into many branches. One of these branches gave a communicating branch to cervical branch of facial nerve outside the parotid gland. Nerve endings of the remaining branches were found to penetrate the interlobular septa and a few of them were seen deep in the gland along the ducts and near the vessels. The functional significance of anatomic variations of nerve endings in relation to ducts, thin vessels deep in the parotid gland, observed in the present case are yet to be evaluated...

Las comunicaciones entre los ramos del plexo cervical y ramo cervical del nervio facial son comunes y bien conocidos. Sin embargo, esta comunicación por lo general ocurre entre el nervio cervical transverso y el ramo cervical del nervio facial. Durante las clases de disección de rutina para los estudiantes de pregrado de medicina, nos encontramos con una variante anatómica de la división anterior del nervio auricular mayor, unilateral, en un cadáver de sexo masculino de 60 años, del Sur de la India. El nervio auricular mayor se originó desde el bucle de los ramos ventrales de los nervios espinales C2 y C3, y dividió en ramos anterior y posterior. El ramo anterior se dirigió oblicuamente hacia arriba y adelante sobre la superficie del músculo esternocleidomastoideo junto con la vena yugular externa hacia el ápice de la glándula parótida y se dividió en numerosos ramos terminales. Uno de estos ramos dió un ramo comunicante al ramo cervical del nervio facial fuera de la glándula parótida. Las terminaciones nerviosas de los ramos restantes penetraron en los septos interlobulares. Algunos de éstos se observaron profundos en la glándula a lo largo de los conductos y cerca de los vasos. La importancia funcional de las variaciones anatómicas de las terminaciones nerviosas en relación a los conductos y vasos finos profundos en la glándula parótida aquí observados aún no se han evaluado...

Case report of high origin of radial, ulnar, and profunda brachii arteries, its clinical implications and review of the literature / Relato de caso de origem alta das artérias radial, ulnar e braquial profunda, suas implicações clínicas e revisão de literatura

Arterial variations in the arm are of potential clinical implications as it is a frequent site of injury and also involved in many surgical and invasive procedures. During a dissection of the right upper extremity, an abnormal high origin of the radial and ulnar arteries was found. The brachial artery had a very short segment without any branches, divided into the radial and ulnar arteries at the upper third of the arm. The course and branching pattern of these radial and ulnar arteries in the arm are discussed. It was also observed that the profunda brachii artery was represented by two separate branches arising from the posterior circumflex humeral artery. Accurate knowledge of these variation patterns is of considerable clinical importance in the conduct of reparative surgeries around the shoulder and fracture management of the humerus. These additional data of arterial anomalies to contemporary anatomical literature are of interest to clinicians, in particular vascular and plastic surgeons and radiologists.

As variações arteriais no braço têm potenciais implicações clínicas já que o braço é um sítio de lesões frequentes, além de estar envolvido em muitos procedimentos cirúrgicos e invasivos. Durante a dissecção da extremidade superior direita, uma origem alta anormal das artérias radial e ulnar foi encontrada. A artéria braquial apresentava um segmento muito curto sem quaisquer ramos, dividindo-se nas artérias radial e ulnar no terço superior do braço. O curso e o padrão de ramificação das artérias radial e ulnar no braço são discutidos. Também se observou que a artéria braquial profunda estava representada por dois ramos separados, surgindo da artéria umeral circunflexa posterior. O conhecimento preciso sobre esses padrões de variação é de considerável importância na realização de cirurgias reparadoras na região do ombro e no manejo de fraturas de úmero. Estes dados adicionais sobre as anomalias arteriais para a literatura anatômica contemporânea são de grande interesse para os médicos, especialmente para cirurgiões plásticos e vasculares e radiologistas.

Petroleum ether extract of Cissus quadrangularis (LINN) stimulates the growth of fetal bone during intra uterine developmental period: a morphometric analysis

OBJECTIVE: The aim of the present study was to analyze the effect Cissus quadrangularis plant petroleum ether extract on the development of long bones during the intra-uterine developmental stage in rats. METHODS: Pregnant rats (n=12) were randomly assigned into either a control group (n=6) or a Cissus quadrangularis treatment (n=6) group. Pregnant rats in the Cissus quadrangularis group were treated with Cissus quadrangularis petroleum ether extract at a dose of 500 mg/kg body weight from gestation day 9 until delivery. The animals in the control group received an equal volume of saline. Newborn pups were collected from both groups for alizarin red S - alcian blue staining to differentiate ossified and unossified cartilage. The ossified cartilage (bone) was morphometrically analyzed using Scion image software. RESULTS: Morphometric analysis revealed that the percentage of the total length of ossified cartilage (bone) in pups born to treated dams was significantly higher (P<0.001- -0.0001) than that of the control group. CONCLUSION: The results of the present study suggest that maternal administration of Cissus quadrangularis petroleum ether extract during pregnancy can stimulate the development of fetal bone growth during the intra-uterine developmental period.