Variation in the insertion of the latissimus dorsi & its clinical importance.

The latissimus dorsi is the larger, flat, dorso-lateral muscle on the trunk, posterior to the arm, and partly covered by the trapezius on its median dorsal region. Origin of the latissimus dorsi is from spinous processes of thoracic T7-T12, thoracolumbar fascia, iliac crest and inferior 3 or 4 ribs, inferior angle of scapula and insertion on floor of intertubercular groove of the humerus. We have studied 50 cadavers in the different medical colleges in which we found 2% case of anterior and posterior slip of the muscle fibers with their extension up to the pectoralis major and teres major respectively. Usually, latissimus dorsi involve in extension, adduction, transverse extension also known as horizontal abduction, flexion from an extended position, and internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine. The latissimus dorsi may be used for the tendon graft surgeries. Tight latissimus dorsi has been shown to be one cause of chronic shoulder pain and chronic back pain. Because the latissimus dorsi connects the spine to the humerus, tightness in this muscle can manifest as either sub-optimal glenohumeral joint function (which leads to chronic shoulder pain) or tendinitis in the tendinous fasciae connecting the latissimus dorsi to the thoracic and lumbar spine. Latissimus dorsi used for pedicle transplant rotator cuff repair reconstruction of breast, face, scalp and cranium defect. The extra slip of the latissimus dorsi may puzzle any transplant operations. We as anatomist discuss the clinical implication of the extra slip of latissimus dorsi.

Occupational radiation exposure in health care facilities.

BACKGROUND: Radiation, which is used extensively to diagnose and treat human diseases, poses an occupational health risk for the concerned health workers. Personal dosimetry is an important tool to monitor occupational radiation exposures. OBJECTIVE: This study was conducted to reveal and to describe the situation of occupational radiation exposure monitoring among staffs in different health care facilities in Nepal. METHODS: A cross-sectional study was performed among the 35 Health Care Facilities. Information about types and number of X-ray procedures performed, types and number of personnel involved, workload and the availability of personal dosimetry service were collected. RESULTS: Six Health Care Facilities had personal dosimetry service available for a total of 149 personnel. Of a total of nearly one million X-ray procedures performed in the 35 Health Care Facilities in 2007, 76 percent was performed by non-monitored personnel. The majority of the facilities performing high dose procedures, like catheterisation, angiography and intestinal barium procedures did not offer personal dosimetry for the involved personnel. CONCLUSION: There are a limited number of personnel being monitored with personal dosimetry. There are no regulatory dose limits for occupationally exposed staff. Thus, there is an urgent need to establish a national radiation protection authority to regulate the use of radiation in Nepal.

Prediction of cancer cases for a hospital in Nepal: a statistical modelling.

OBJECTIVE: The aim of this study was to predict the number and trends of cancer cases for radiotherapy up to the year 2015 in Manipal Teaching Hospital, Pokhara, Nepal. METHODS: A retrospective study was carried out on data retrieved from the radiotherapy treatment records of patients treated at Manipal Teaching Hospital between 28 September 2000 and 31 December 2008. Different statistical programmes were used for statistical modelling and prediction. Using curve-fitting methods, Linear, Logarithmic, Inverse, Quadratic, Cubic, Compound, Power, Exponential, and Growth models were tested. RESULTS: Including constant term, none of the models were best fitted. However, excluding the constant term, the cubic model was best fitted; R2=0. 95, p=0.001 for total cancer cases, R2=0. 94, p=0.001 for female cancer cases and R2=0. 95, p=0.001 for male cancer cases. The cancer cases estimated using cubic model showed a steady increase in the total frequency of cancers (including male and female cancer cases) following the year 2010. The three most common cancers reported were head and neck 24.2% (CI 21.6 - 27.0), lung 20.9% (CI 18.4 -23.6), cervix 15.9% (CI 13.7-18.3) respectively. CONCLUSION: The cancer cases in need of radiotherapy will increase in future years. The curve fitting method could be an effective exploratory modelling technique for predicting cancer frequency and trends over the years.

Cancer treatment by radiotherapy in Western Nepal: a hospital-based study.

OBJECTIVE: The aim of this study was to describe utilization of radiotherapy and treatment compliance in the context of Nepal. METHODS: A retrospective study was carried out on data collected from the radiotherapy treatment records of patients treated at Manipal Teaching Hospital (MTH), Pokhara, between 28 September 2000 and 30 May 2008. RESULTS: In the 944 patients, the gender distribution showed a slight female preponderance (53.7 vs. 46.3%). Curative treatment was given to 62.8% (n= 593) and palliative to the remaining 37.2% (n= 351). Patients older than 50 years were more likely to receive palliative radiotherapy (p= 0.001). The commonest cancers treated were head and neck at 23.7% (n= 224), followed by lung at 21.3% (n= 201) and cervix at 16.1% (n= 152). The majority of patients were between 50-70 years of age (n= 564). Nineteen percent (n= 179) did not complete the prescribed dose of radiation. Unplanned treatment interruptions were found in 35.6% (n= 336) and this was not affected by age (p= 0.1) or gender (p= 0.1). The most frequent treatment interruption compromising optimal effectiveness of cancer treatment was observed for head and neck cancers, constituting 43% (n= 96) of patients in the group. CONCLUSION: Head and neck in both sexes and cervix in females were the most common cancers treated with a curative intent. Lung cancer, the second most common in both genders, was treated with palliative intent in a large number of cases. This indicates the need for early diagnosis for a possible curative treatment.