Sushma R Kotian

An unorthodox innervation of the gluteus maximus muscle and other associated variations: A case report.

Knowledge of peripheral nerve morphology, location, and variation is important for facilitating appropriate diagnosis and intervention. We present a unique case of absence of the inferior gluteal nerve and high division of the sciatic nerve. In this instance, the common peroneal nerve was found piercing the piriformis muscle and emerging distally in the form of two trunks: thin medial and thick lateral. The medial trunk presented an interesting course, supplying the gluteus maximus muscle before joining the lateral trunk to form the common peroneal nerve. Additionally, the arteria nervi ischiadisci was also observed accompanying and supplying the tibial nerve passing inferior to the piriformis. These variations are important for clinicians and surgeons for some radiological diagnoses and surgical procedures in the lower limb.

Effects of lead in various preparatory stages of Nagabhasma on function and histopathology of cornu ammonis of hippocampus

INTRODUCTION Heavy metals are frequently used in the preparations of traditional/folk medicines. One such preparation in Ayurveda is Nagabhasma, in which lead is the main ingredient. Lead is non-essential element to the human body and is known toxic substance to many organ systems. However, it is claimed that, the highly toxic metallic lead will be converted into health beneficial organo-metallic compound when raw lead is subjected to various traditional methods of purification during preparation as mentioned in the ancient medicinal system. AIM The present study is designed to evaluate the effect of such detoxification of lead in various stages of authentically prepared Nagabhasma on the learning and memory. MATERIALS AND METHODS Using half of the human equivalent doses of traditionally prepared Nagabhasma, at intermittent stages of its preparation were fed orally to healthy Wistar rats for 30 days. After treatment, the immediate effect and residual effect after 2 months was evaluated by subjecting them to passive avoidance test. Then rats were sacrificed and hippocampus was collected for histopathological evaluation. RESULTS Pure lead treated animals showed deficit in learning and memory which is indicated by spending more time in the dark compartment in passive avoidance test. However, animals treated with stage 1 to 4 Nagabhasma showed gradual increase in the memory and learning. This observation is substantiated by the findings of the histopathology of the Cornu Ammonis (CA) region of hippocampus. CONCLUSION The results of the present study indicate that, the metallic toxicity of the lead used in the preparation of bhasma was gradually decreased from stage 1 to stage 4 of preparation. Therefore, the traditional way of preparing the metallic bhasma is very critical in eliminating the possible health hazardous metallic lead toxicity.

Anatomical variations of the lumbar plexus in fetus

The lumbar plexus is formed within the psoas major muscle and is one of the main nervous pathways supplying the lower limb. Although we came across literature concerning the variations in lumbar plexus in adults, there is dearth of the same in foetuses. Aim of the study was to study the variations in lumbar plexus in foetus. The study was done bilaterally in 25 formalin-fixed fetuses (10 females, 15 males), age ranging from 20 to 37 weeks of gestation. The formation of lumbar plexus and their branching pattern were observed. The findings were noted and tabulated. Multiple variations were observed in the formation and branching pattern of lumbar plexus. Anatomical variations found in the present case may be injured during certain surgical procedures in infants and children, particularly in the lower abdominal region, e.g. appendectomy, inguinal hernia repair, iliac crest bone graft harvesting etc. As a consequence to such operations, several clinical conditions may be encountered such as meralgia paresthetica, groin pain and testicular pain in which the lateral femoral cutaneous, ilioinguinal and the genitofemoral nerves are mostly involved. Thus, awareness about the regional anatomy and its variations is essential for preventing intra-operative complications.

Additional Muscle Slip of Bicipital Aponeurosis and its Anomalous Relationship with the Median Cubital Vein

The cubital region of the arm is a common site for recording blood pressure, taking blood for analysis and administering intravenous therapy and blood transfusions. During the routine dissection of a 70-year-old male cadaver at the Kasturba Medical College, Manipal, Karnataka, India, in 2015, it was observed that the aponeurotic insertion of the biceps brachii muscle divided into two slips. The medial slip fused normally with the deep fascia of the forearm, while flexor carpi radialis muscle fibres originated from the lateral slip. There was also a single vein in the forearm, the cephalic vein, which bifurcated to form the median cubital vein and the cephalic vein proper. The median cubital vein, further reinforced by the radial vein, passed deep to the two slips of the bicipital aponeurosis and then continued as the basilic vein. During venepuncture, medical practitioners should be aware of potential cubital fossa variations which could lead to nerve entrapment syndromes.

A Study of Physicochemical Properties of Subcutaneous Fat of the Abdomen and its Implication in Abdominal Obesity.

INTRODUCTION The lower abdominal obesity is more resistant to absorption as compared to that of upper abdomen. Differences in the physicochemical properties of the subcutaneous fat of the upper and lower abdomen may be responsible for this variation. There is paucity of the scientific literature on the physicochemical properties of the subcutaneous fat of abdomen. AIM The present study was undertaken to create a database of physicochemical properties of abdominal subcutaneous fat. MATERIALS AND METHODS The samples of subcutaneous fat from upper and lower abdomen were collected from 40 fresh autopsied bodies (males 33, females 7). The samples were prepared for physicochemical analysis using organic and inorganic solvents. Various physicochemical properties of the fat samples analysed were surface tension, viscosity, specific gravity, specific conductivity, iodine value and thermal properties. Data was analysed by paired and independent sample t-tests. RESULTS There was a statistically significant difference in all the physicochemical parameters between males and females except surface tension (organic) and surface tension (inorganic) of upper abdominal fat, and surface tension (organic) of lower abdominal fat. In males, viscosity of upper abdominal fat was more compared to that of lower abdomen (both organic and inorganic) unlike the specific conductivity that was higher for the lower abdominal fat as compared to that of the upper abdomen. In females there were statistically significant higher values of surface tension (inorganic) and specific gravity (organic) of the upper abdomen fat as compared to that of lower abdomen. The initial and final weight loss of the lower abdominal fat as indicated by Thermo Gravimetric Analysis was significantly more in males than in female. CONCLUSION The difference in the physicochemical properties of subcutaneous fat between upper and lower abdomen and between males and females could be responsible for the variant behaviour of subcutaneous abdominal fat towards resorption.

Anatomy of maxillary sinus and its ostium: A radiological study using computed tomography

Background: Interventions involving the middle meatus are commonly performed because the majority of the paranasal sinuses open into the osteomeatal complex. Therefore, the aim of the present study was to locate the level of maxillary sinus ostium (MSO), to measure the distances between MSO and different anatomical landmarks, to measure the different dimensions of maxillary sinus and to compare the morphology of maxillary sinus between the right and the left sides. Materials and Methods: The study involved 50 computed tomography (CT) images of normal paranasal sinus anatomy in coronal and sagittal planes from the Department of Radiodiagnosis. The location of the sinus ostium (upper, middle, or lower third) was observed. Perpendicular distance from the sinus ostium to the lower border of inferior turbinate and hard palate were measured. The maximum vertical, transverse, and antero-posterior diameters of the maxillary sinus were measured. Results: Of 50 CT images, the MSO was located in the upper third in 40 cases while in 10 it was located in the middle third. The most common location of MSO was in the upper third. The dimensions of the maxillary sinus indicated bilateral symmetry. Conclusion: The dimensions of the maxillary sinus indicated bilateral symmetry, and there were no significant gender differences when compared. However, the distances of the MSO from the major anatomical landmarks were significantly different between males and females which are seldom reported earlier. This knowledge about the variations in the lateral wall of the nasal cavity is crucial during the endoscopic interventions and for functional endoscopic sinus surgeries.

Histological and biochemical study of the superficial abdominal fascia and its implication in obesity.

The advancement of liposculpturing and fascial flaps in reconstructive surgery has renewed interest in the superficial fascia of abdomen. Its histological and biochemical composition may play a vital role in maintaining strength and elasticity of the fascia. Hence, study of abdominal fascia for the elastic, collagen, and hydroxyproline contents is desirable to understand asymmetrical bulges and skin folds and in improving surgical treatment of obesity. Samples of superficial fascia were collected from of upper and lower abdomen from 21 fresh cadavers (15 males and 6 females). Samples were stained using Verhoeff–Van Gieson stain. Digital images of superficial fascia were analyzed using TissueQuant software. The samples were also subjected to hydroxyproline estimation. The superficial fascia was formed by loosely packed collagen fibers mixed with abundant elastic fibers and adipose tissue. Elastic contents and collagen contents of superficial fascia were significantly more in the upper abdomen than that in the lower abdomen in males. Hydroxyproline content of superficial fascia of upper abdomen was significantly more than that of lower abdomen in both males and females. The elastic, collagen and hydroxyproline contents of superficial fascia of upper abdomen were higher compared to the lower abdomen. This may be a reason for asymmetric bulging over abdomen and more sagging fold of skin in the lower abdomen than in the upper abdomen. This study may therefore be helpful in finding new ways to manage obesity and other body contour deformities.

Morphometry of subcutaneous fat lobules of the abdomen and its implication in obesity

Aim: The subcutaneous fat in the lower abdomen (LA) is more resistant to resorption as compared to the upper abdomen (UA). Males and females have variability in fat deposition and resorption in the abdominal region. Hence, there could be a difference in morphology of fat cells of these regions. The present study aims to identify the differences in morphology of subcutaneous fat lobules of upper and LA. Methods: Subcutaneous fat samples were collected from upper and LA of 40 cadavers (33 males and 7 females). The shape, the arrangement, and the color of superficial and deep subcutaneous fat lobules were observed. The height and width were recorded for larger fat lobules. Results: There was a difference in the color, shape, size, and arrangement of the fat lobules between the two locations. Height (P = 0.042) and width (P = 0.008) of deep subcutaneous fat of LA were significantly larger than the UA in males while the height of superficial fat (P = 0.016) was significantly larger in LA than the UA in females. Height of the deep fat of UA (P = 0.018) and width of deep fat of the LA (P = 0.020) were significantly larger in females as compared to males. Conclusion: There was a significant difference in the morphology of the superficial and deep subcutaneous fat based on location and gender of the patient.

Cleidohyoideus Accessorius - Boyun Bölgesinde İlave İnfrahyoid Kası

Variations of the muscles in the infrahyoid region assume clinical significance during diagnostic and surgical procedures in the region of neck. Accessory muscles are rare anatomical variants which may have clinical implications. The present case reports the existence of an accessory muscle, the cleidohyoid. The muscle was unilaterally observed arising from the upper surface of the middle of the clavicle and inserting into the hyoid bone. The occurrence of this muscle in the densely packed region as in the neck may have functional, diagnostic, surgical and pathological implications.

Surgical relevance of sphenoid sinus and its ostium: An anatomical study -

Back ground: Sphenoid sinuses and their ostia are highly variable structures. Normal opening of sphenoid sinus lies in the spheno ethmoidal recess medial to superior turbinate. The sphenoid sinus is surrounded by several important structures like optic nerve, carotid arteries and the trigeminal nerves. Objective: The present study was performed to determine the anatomical correlations of the sphenoid sinus ostium with surrounding structures. Materials and Methods: The study was carried out in the Department of Anatomy, Kasturba Medical College, Manipal on 40 sagittal head and neck sections of adult formalin fixed cadavers. The shape of the sphenoid sinus ostia was noted. The distance of the ostium from the major landmarks were measured using vernier calipers. The landmarks used were the choana, nasion, anterior end of superior concha and basi sphenoid. The extent of pneumatization towards the sella was also noted. Results: In our study, majority of cases showed sellar variety on both right and left side. The shape of the sphenoid sinus ostia was slit type in majority of cases followed by oval and round shape. Conclusion: The sphenoid ostium provides a natural portal for entering the sphenoid sinus and beyond up to the base of the skull. It is not always easy to locate the ostium during endoscopic approach. The present study was therefore designed to establish readily identifiable anatomical landmarks for locating the sphenoid ostium.