Azian Abd Latiff

The effect of topical extract of Momordica charantia (bitter gourd) on wound healing in nondiabetic rats and in rats with diabetes induced by streptozotocin

Background.  Momordica charantia (MC; bitter gourd) is a traditional herb commonly used for its antidiabetic, antioxidant, contraceptive and antibacterial properties. It is also used for the rapid healing of wounds.

Evaluation of topical tocopherol cream on cutaneous wound healing in streptozotocin-induced diabetic rats

Diabetes is a common cause of delayed wound healing. The aim of the study was to determine the effect of topical administration of tocopherol cream on the wound healing process in diabetic rats. The study was conducted using 18 male Sprague Dawley rats which were divided into three groups: (I) diabetic rats receiving control cream (n = 6), (II) diabetic rats receiving 0.06% tocopherol cream (n = 6), and (III) diabetic rats receiving 0.29% tocopherol cream (n = 6). Four cutaneous wounds were created at the dorsal region of the rats. Wound healing was assessed by total protein content, rate of wound closure estimation, and histological studies on the tenth day after wounding. Tocopherol treatment enhanced the wound healing process by increasing rate of wound closure and total protein content significantly (P < 0.05) compared to the control group. Histological observation also showed better organized epithelium and more collagen fibers in the tocopherol treated groups. Application of tocopherol cream enhances wound healing process in diabetic condition which is known to cause delay in wound healing.

Anatomical insight into the normal and abnormal branching pattern of the popliteal artery

We read with much interest the article titled ‘Branching patterns of the popliteal artery and its clinical importance’ by Ozgur et al. [2]. The article describes the normal and abnormal branching pattern of the popliteal artery in 40 lower cadaveric limbs. Perhaps, the sample size is too small to comment on the incidence of anomalous branching pattern. It is pertinent to mention that a recent research study conducted on 1,242 digital subtraction angiographic cases observed the higher origin of the anterior tibial artery in 1.2% cases and trifurcation in 1.5% cases as compared to the present Wndings in 5 and 1% cases, respectively [1]. Thus, it cannot be refuted that the incidence of any anomalous branching pattern of popliteal artery may be directly proportional to the sample size. We are sure that the authors would agree to the fact that evidence of any previous surgery cannot be speculated merely by observing the specimens, rather a detailed surgical patient history may be beneWcial. The presence of anomalous branching pattern of the popliteal artery may be due to any embryological defects, racial variance or even acquired in nature. It is interesting for any anatomist to explore the possible embryological reasons behind the existence of such anomalies. Anatomists have described that the branching patterns of the popliteal artery are related to the combinations of the sciatic and primary femoral arteries, which grow into the primordium of the lower limb [3]. While, the popliteal and peroneal arteries are believed to be the remnants of sciatic artery, the anterior tibial artery arises from the anterior germ [3]. The detailed Wndings of anomalous branching pattern of the popliteal artery along with the embryological reasons and clinical implications were found in an important reference which could have been incorporated [3]. The diameter of the popliteal artery, tibial-peroneal trunk, anterior tibial artery, peroneal artery was meticulously measured but no signiWcant clinical implications related to the diameter were described. In fact, during any graft surgery, the luminal diameter of the vessel wall may be vital for any prior planning. Vascular surgeons deal with the morphometric measurements of the vessel wall while performing any bypass surgery. The authors mention that the tortuous tibial-peroneal trunk may be related to atherosclerosis. In such a case, it is always advisable to perform special histological staining for the vessel wall for observing the presence of any atheromatous lesion in the vessel wall. Tortuosity may not be linked to atherosclerosis rather it may be linked to stretching. Overall, an interesting article which may initiate a long debate. One really wonders how any anatomical measurement holds good against the far superior and reliable angiographic studies of recent times. The clear illustrations with comparison to past research works make the present article very interesting. The authors and the editor deserve special credit for highlighting such an important clinical topic.

Commentary on: Cameriere R, Ferrante L, Molleson T, Brown B. Frontal sinus accuracy in identification as measured by false positives in kin groups. J Forensic Sci 2008;53(6):1280-2.

Sir, We read with much interest the article titled ‘‘Frontal Sinus Accuracy in Identification as Measured by False Positives in Kin Groups’’ by Cameriere et al. (1). It is an informative article with regard to any identification of an individual but the accuracy may be questioned. The frontal sinus is the one of the sinuses which is rudimentary at birth and it develops later on. Interestingly, past research reports depict that the anatomical variations of the nose and paranasal sinuses are more common in children and the prevalence of such varies according to the development of these sinuses during childhood (2). An interesting point which may be raised is the similarity in the anatomy of the paranasal sinuses in twins. A past study reported the fact that the differences in anatomical structure of the paranasal sinuses between identical and non-identical twin pairs were not statistically significant (3). This gives enough evidence to believe that the environmental factors are more important than the genetic ones for the development of these anatomical variants of paranasal sinuses (3). It has also been reported that old age may account for the bony resorption thereby leading to alteration in the size of the frontal sinus (4). Hence, frontal sinus size may vary with increase in age. As per research studies, in any individual, the size of the frontal sinus increases up to 19 years (4). Thus, anatomy of the frontal sinus is bound to vary even in the same family members as it is influenced by different factors like environment and age rather than being specifically linked to any genetic cause. The bilateral absence of the frontal sinus in 10% of cases as reported in the present study appears to be interesting. The authors have rightfully commented that we cannot identify the kinship of an individual with observation of the frontal sinus, rather it may be used to identify skeletal remains (1). Overall, it is an interesting topic with a lucid style of representation and the authors need to be commended for their work.

Radial nerve palsy: True anatomical facts

To the Editor: We read with much interest the paper titled ‘‘Radial nerve palsy in the newborn: a report of 4 cases and literature review’’ by Monica et al We do agree that birth injuries related to the radial nerve are rare. It may be mentioned that the authors use the term ‘‘function of muscles,’’ which is incorrect. In medical terminology, we usually define it as an action of the muscle, not as a function. The first sentence of the case report section is highly confusing: ‘‘At birth, allydigital flexion’’. The sentence implies that there was loss of extension of wrist with intact active wrist. According to the authors, there was involvement of the posterolateral part of the arm. The posterior part of the arm is innervated by the posterior cutaneous branch of the radial nerve. In fact, before entering the radial groove, the cutaneous branch to the arm is given. According to the standard anatomy textbook, the posterior cutaneous nerve arises in the region of the axilla. In the radial groove, the radial nerve gives off the lower lateral cutaneous nerve of the arm. Thus, according to the present findings, the posterior cutaneous nerve and the lateral cutaneous nerve are involved. If the lateral cutaneous nerve was involved, it means that the damage was there in the spiral groove and this would imply the obvious involvement of the lateral and medial head of the triceps, which was not observed by the authors; instead the authors mentioned the intact deltoid, biceps, and triceps. If the posterior interosseous nerve (a branch of the radial nerve) is involved in the forearm, then the radial wrist extension and brachioradialis muscle action will be normal. The authors did not mention these facts. The sensory loss in the area of the radial nerve innervation of the dorsum of the hand was not evaluated. The authors mentioned the term ‘‘active shoulder function’’ in the last paragraph. There are various movements taking part in the shoulder joint, with different muscles performing different actions. I suggest that the phrase ‘‘active shoulder function’’ should be explained further. It is not well understood what the authors mean by stating that ‘‘posterior cord involvement can be distinguished from isolated radial nerve palsy, if deltoid weakness is present’’. In fact, deltoid is innervated by the axillary nerve (branch from posterior cord), which has a root value C5, C6 while the radial nerve has a root value of C5, C6, C7, C8, T1 (also a branch from the posterior cord). There are other nerves that arise from the posterior cord, such as the upper and lower subscapular nerve (C5, C6) and the nerve to the latissimus dorsi (C6, C7, C8), and therefore how can the posterior cord involvement be distinguished from isolated radial nerve palsy? The term ‘‘active digital flexion’’ is rather vague. There are 5 digits and the flexion of the second and the third digit is caused by the lateral part of the flexor digitorum profundus and the first and second lumbricals, which are innervated by the median nerve, unlike the medial fourth and fifth digit, which are innervated by the medial part of the flexor digitorum profundus, and the third and fourth lumbricals, which are innervated by the ulnar nerve. Unless the precise locations of the involved digits are highlighted, this is a vague description. In the last sentence, the authors state that the site of injury is distal to the spiral groove. In that case, the involvement of innervated muscles such as the brachioradialis, the brachialis and the extensor carpii radialis should have been tested. Mere speculation may not explain the 4 cases, but a detailed approach to the exact level of injury and the involvement of the muscles gives a better picture. Overall, this is an interesting topic for discussion that may benefit pediatric orthopaedicians, clinicians, and anatomists. The authors and the editorial board need to be applauded for highlighting such an important topic.