Soubhagya R. Nayak

Anatomical organization of aortic arch variations in the India: embryological basis and review

OBJETIVOS: Determinar a porcentagem e o tipo de variacoes do arco aortico em individuos indianos, bem como sua importância clinica e cirurgica e base embriologica. PACIENTES E METODOS: Em nossa investigacao, os padroes de ramificacao do arco aortico foram estudados em 62 cadaveres fixados em formalina de ambos os sexos, de origem indiana e com idade entre 45 e 79 anos. As dissecacoes foram realizadas em cadaveres preservados em formalina, e as variacoes do arco aortico foram observadas apos a exposicao das regioes toracica e cervical durante a dissecacao de rotina de alunos da graduacao do Kasturba Medical College, Mangalore, India. RESULTADOS: O arco aortico normal de tres ramificacoes foi encontrado em 56 cadaveres (91,4%); as variacoes foram encontradas em seis cadaveres (9,6%); 4,8% apresentavam origem comum das arterias carotidas; 1,6% tinham sequencia binominada, e o mesmo especime tinha a origem da arteria coronaria esquerda diretamente no arco aortico; 1,6% apresentavam a origem da arteria subclavia direita diretamente na aorta; 1,6% tinham como ramificacao do arco aortico uma arteria vertebral esquerda. Cinco de seis cadaveres com padrao de ramificacao anomalo do arco aortico eram do sexo feminino. Um cadaver do sexo masculino apresentou origem anomala da arteria vertebral esquerda diretamente no arco. CONCLUSAO: O amplo espectro de variacoes nos padroes anatomicos das ramificacoes do arco aortico na populacao indiana estava em concordância com outras populacoes mundiais. Embora as origens anomalas das ramificacoes do arco aortico sejam meramente variacoes anatomicas, informacoes precisas sobre elas e essencial para a cirurgia vascular na regiao do torax, cabeca e pescoco.

Petroleum ether extract of Cissus quadrangularis (Linn.) enhances bone marrow mesenchymal stem cell proliferation and facilitates osteoblastogenesis.

OBJECTIVE To evaluate the effects of the petroleum ether extract of Cissus quadrangularis on the proliferation rate of bone marrow mesenchymal stem cells, the differentiation of marrow mesenchymal stem cells into osteoblasts (osteoblastogenesis) and extracellular matrix calcification. This study also aimed to determine the additive effect of osteogenic media and Cissus quadrangularis on proliferation, differentiation and calcification. METHODS MSCs were cultured in media with or without Cissus quadrangularis for 4 weeks and were then stained for alkaline phosphatase. Extracellular matrix calcification was confirmed by Von Kossa staining. marrow mesenchymal stem cells cultures in control media and osteogenic media supplemented with Cissus quadrangularis extract (100, 200, 300 μg/mL) were also subjected to a cell proliferation assay (MTT). RESULTS Treatment with 100, 200 or 300 μg/mL petroleum ether extract of Cissus quadrangularis enhanced the differentiation of marrow mesenchymal stem cells into ALP-positive osteoblasts and increased extracellular matrix calcification. Treatment with 300 μg/mL petroleum ether extract of Cissus quadrangularis also enhanced the proliferation rate of the marrow mesenchymal stem cells. Cells grown in osteogenic media containing Cissus quadrangularis exhibited higher proliferation, differentiation and calcification rates than did control cells. CONCLUSION The results suggest that Cissus quadrangularis stimulates osteoblastogenesis and can be used as preventive/ alternative natural medicine for bone diseases such as osteoporosis.

Supratrochlear foramen of the humerus: An anatomico-radiological study with clinical implications

Background. The supratrochlear foramen (STF) of the humerus has been a neglected entity in standard anatomy and orthopaedics text-books. The knowledge of the presence of STF in a humerus may be important for preoperative planning for treatment of supracondylar fractures. The presence of STF may also result in erroneous interpretation of radiographs. Methods. The STF was studied in detail in 384 (220 left side and 164 right side) human dried humeri of unknown sex and age. The topographical anatomy of the STF was studied in detail, morphometric measurements were taken, and the specimens were photographed. The humerus was also taken for radiological assessment of the STF and supratrochlear septum. Results. Out of the 384 bones studied, 132 cases (34.3%) showed the presence of STF. The STF was oval, round, and triangular in shape in 123, 7, and 2 cases, respectively. The mean length of the transverse diameter for supratrochlear foramen was 6.55 mm and 5.99 mm on the left and right sides, respectively. The mean length of the vertical diameter for STF was 4.85 mm and 3.81 mm on the left and right sides, respectively. Most of the bones that had no STF showed a translucency of septum, in 56.7% of the bones. Conclusions. The results of our study show that STF is more common on the right side, with the oval shape being more common. The respective sides did not exhibit any statistical significant differences. Presence of STF may be important for anthropological, clinical, and academic purpose.

Evidence-based assessment of antiosteoporotic activity of petroleum-ether extract of Cissus quadrangularis Linn. on ovariectomy-induced osteoporosis

The increasing incidence of postmenopausal osteoporosis and its related fractures have become global health issues in the recent days. Postmenopausal osteoporosis is the most frequent metabolic bone disease; it is characterized by a rapid loss of mineralized bone tissue. Hormone replacement therapy has proven efficacious in preventing bone loss but not desirable to many women due to its side-effects. Therefore we are in need to search the natural compounds for a treatment of postmenopausal symptoms in women with no toxic effects. In the present study, we have evaluated the effect of petroleum-ether extract of Cissus quadrangularis Linn. (CQ), a plant used in folk medicine, on an osteoporotic rat model developed by ovariectomy. In this experiment, healthy female Wistar rats were divided into four groups of six animals each. Group 1 was sham operated. All the remaining groups were ovariectomized. Group 2 was fed with an equivolume of saline and served as ovariectomized control (OVX). Groups 3 and 4 were orally treated with raloxifene (5.4 mg/kg) and petroleum-ether extract of CQ (500 mg/kg), respectively, for 3 months. The findings were assessed on the basis of animal weight, morphology of femur, and histochemical localization of alkaline phosphatase (ALP) (an osteoblastic marker) and tartrate-resistant acid phosphatase (TRAP) (an osteoclastic marker) in upper end of femur. The study revealed for the first time that the petroleum-ether extract of CQ reduced bone loss, as evidenced by the weight gain in femur, and also reduced the osteoclastic activity there by facilitating bone formation when compared to the OVX group. The osteoclastic activity was confirmed by TRAP staining, and the bone formation was assessed by ALP staining in the femur sections. The color intensity of TRAP and ALP enzymes from the images were evaluated by image analysis software developed locally. The effect of CQ was found to be effective on both enzymes, and it might be a potential candidate for prevention and treatment of postmenopausal osteoporosis. The biological activity of CQ on bone may be attributed to the phytogenic steroids present in it.

A study of anatomical variability of the omohyoid muscle and its clinical relevance

OBJECTIVE The omohyoid muscle is a long, thin muscle consisting of superior and inferior bellies and an intermediate tendon, which runs obliquely in the lateral cervical region. The omohyoid is important in neck dissections because it is the surgical landmark for level III and IV lymph node metastases. METHODS In the present study, the anterior and posterior triangle of the neck was dissected in 35 male cadavers and observed for variations in the omohyoid bilaterally. Observations were focused on variations in number, attachments, and position of omohyoid. RESULTS Among the 35 cadavers studied, double omohyoid was present in one cadaver, inferior belly originated from the clavicle in three cadavers, superior belly merged with the sternohyoid in two cadavers, and the omohyoid received additional slips from the sternum in one cadaver. Standard attachment and position of the omohyoid was observed in the remaining cadavers. CONCLUSION Variations of this muscle are important because of its close relation to the large vessels and brachial plexus. Because of the direct adhesion of the intermediate tendon to the anterior wall of the internal jugular vein and its connection with it through a thin lamina of the pretracheal layer of the cervical fascia, the contraction of the omohyoid muscle has a direct effect on the lumen of this vessel.

The accessory heads of flexor pollicis longus and flexor digitorum profundus: Incidence and morphology

Kiloh–Nevin syndrome caused by compressive neuropathy of the anterior interosseous nerve in the forearm is believed to occur because of its compression by the accessory head of flexor pollicis longus (FPLah). Gantzer described two accessory muscles, the more frequent is the FPLah and the less frequently observed is the flexor digitorum profundus accessory head (FDPah). Many studies have reported the prevalence, origin, insertion, nerve supply, and relations of these accessory muscles, most of them focusing on the FPLah. This study was designed to investigate the prevalence, morphology, relation to median and anterior interosseous nerve, and also the coexistence of both the accessory heads. A total of 126 upper limbs of the embalmed cadavers were examined in this study. Fifty‐eight limbs (46.03%) showed the presence of the FPLah and 18 limbs (14.28%) had the FDPah. The most common origin of both the accessory muscle bellies was from the under surface of the flexor digitorum superficialis. The FPLah inserted into the FPL muscle at varying levels with 80% inserting into the proximal third of FPL, whereas the FDPah in all cases ended near the level of the wrist joining with one or more tendons of the FDP. Clinical implication of the variation is discussed. Clin. Anat. 21:252–258, 2008.

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.

Pterygospinous bar and foramina in Indian skulls: incidence and phylogenetic significance

Incomplete or complete ossification of the pterygospinous ligament is uncommon. Entrapment of mandibular nerve and its branches was reported due to this anatomical variation, when found. The aim of the present study is to investigate the incidence of the pterygospinous bony bridges in Indian dry skulls. A total of 416 adult dry skulls of Indian origin were studied. In 9.61% of the samples the pterygospinous bony bars were found, out of which 5.76% was complete and 3.84% was incomplete. Such variations are of clinical significance while dealing with mandibular nerve and its branches and various clinical symptoms related to it.

A rare case of bilateral sternocleidomastoid muscle variation

An abnormal sternocleidomastoid (SCM) muscle was encountered bilaterally during routine dissection of the head and neck region of a 60 year old male cadaver. The SCM muscle of both the sides had an additional sternal head arising from the capsule of the sternoclavicular joint and the supero-lateral border of the manubrium sterni. The clinical significance of the present variation is immense, as it might cause difficulty in assessing the vital neurovascular structures of the neck during surgical procedure.

Anatomical variation of radial wrist extensor muscles: a study in cadavers

OBJECTIVE The tendons of the extensor carpi radialis longus and brevis muscles are quite useful in tendon transfer, such as in correction of finger clawing and restoration of thumb opposition. Knowledge of additional radial wrist extensor muscle bellies with independent tendons is useful in the above-mentioned surgical procedures. METHODS The skin, subcutaneous tissue, and antebrachial fascia of 48 (24 on the right side and 24 on left side) male upper limb forearms were dissected. The following aspects were then analyzed: (a) the presence of additional muscle bellies of radial wrist extensors, (b) the origin and insertion of the additional muscle, and (c) measurements of the muscle bellies and their tendons. RESULTS Five out of 48 upper limbs (10.41%) had additional radial wrist extensors; this occurred in 3 out of 24 left upper limbs (12.5%) and 2 out of 24 right upper limbs (8.3%). In one of the right upper limbs, two additional muscles were found. The length and width of each additional muscle belly and its tendon ranged between 2 – 15cm by 0.35 – 6.4cm and 2.8 – 20.8cm by 0.2 –0.5cm, respectively. The additional radial wrist extensor tendons in our study basically originated either from the extensor carpi radialis longus or brevis muscles and were inserted at the base of the 2nd or 3rd metacarpal bone. CONCLUSION The present study will inform surgeons about the different varieties of additional radial wrist extensors and the frequency of their occurrence.