Additional Innervations of Pectoral Muscles by the Intercostobrachial Nerve Associated With Duplication of Medial and Lateral Pectoral Nerves – A Case Report

Variations in the nerves of pectoral region are rare. We observed duplication of medial and lateral pectoral nerves in the left upper extremity of an adult male cadaver.The lateral pectoral nerves entered the pectoralis major muscle above the medial border of the pectoralis minor muscle approximately 2 inches below the clavicle. The medial pectoral nerves pierced the pectoralis minor muscle and entered the pectoralis major muscle approximately 3 and 4 inches below the clavicle. The intercostobrachial nerve, apart from its cutaneous supply in the arm, gave a muscular branch that pierced the pectoralis minor (approximately 4 inches below the clavicle) and entered the pectoralis major muscle. The variations observed were unilateral. Knowledge of variations of these three nerves is of importance to plastic surgeons while raising pectoral flaps and also for other surgeons during breast surgeries and axillary lymph node dissection

Case Report - Marfan syndrome: Report of two cases with review of literature

Marfan syndrome is a variable, autosomal dominant disorder of connective tissue whose cardinal features affect the cardiovascular system, eyes and skeleton. The minimal birth incidence is around 1 in 9800. About three quarters of patients have an affected parent; new mutations account for the remainder. The patient’s prognosis depends on the severity of cardiovascular complications and is mainly determined by progressive dilation of the aorta. If signs of Marfan syndrome are recognized, it is important to refer to the correct health care professional for further testing to prevent associated complications. If not properly treated, premature death may be caused by the severe cardiovascular and pulmonary complications associated with Marfan syndrome. Therefore, it is important to identify this potentially life‑threatening condition in general practice. This article reports two cases with a very typical features of Marfan syndrome

Unusual Cubital Fossa Anatomy – Case Report

The median nerve is known to show variations in its origin, course, relations and distribution. But in almost all cases it passes through the cubital fossa. We saw a cubital fossa without a median nerve. The median nerve had a normal course in the upper part of front of the arm but in the distal third of the arm it passed in front of the medial epicondyle of humerus, surrounded by fleshy fibres of pronator teres muscle. Its course and distribution in the forearm was normal. In the same limb, the fleshy fibres of the brachialis muscle directly continued into the forearm as brachioradialis, there being no fibrous septum separating the two muscles from each other. The close relationship of the nerve to the epicondyle might make it vulnerable in the fractures of the epicondyle. The muscle fibres surrounding the nerve might pull up on the nerve and result in altered sensory-motor functions of the hand. Since the brachialis and brachioradialis are two muscles supplied by two different nerves, this continuity of the muscles might result in compression/entrapment of the radial nerve in it.Keywords: Median nerve, cubital fossa, brachialis, brachioradialis, entrapmen

Presence of Multiple Tendinous Insertions of Palmaris Longus: A Unique Variation of a Retrogressive Muscle

Background: Palmaris longus, being the most variable muscle of the upper extremity is generally considered important morphologically rather than functionally. The palmar aponeurosis represents the distal part of the tendon of Palmaris longus.Case Details: We report here a unique case of palmaris longus presenting variation distally as its tendon divides to gain multiple attachments with the fascia covering the abductor pollicis brevis, flexor retinaculum and the tendon of flexor carpi ulnaris. In addition, it also continues as palmar aponeurosis as its normal course.Conclusion: Presence of this kind of variation might result in compression of the median and ulnar nerves and may aggravate the complications in case of inflammation of palmar aponeurosis thus mimicking the manifestations of Dupuytren’s contracture.Keywords: Palmaris longus, palmar aponeurosis, Dupuytren’s contractur

Case Report: Variant Origin of an Arterial Trunk from Axillary Artery Continuing as Profunda Brachii Artery- A Unique Arterial Variation in the Axilla and its Clinical Implications

Background: Axillary artery is known to show different variations mostly in its branching pattern. Similarly, the origin of profunda brachii is often encountered with abnormality. Therefore, when the vascular variations in the upper limb persist, mostly it is confined to its branching pattern followed by its variant origin. But, among all the reported variations of profunda brachii, its variant origin from the 3rd part of the axillary artery with common trunk for the branches of axillary artery is unique.Case Details: We report here an anomalous origin of profunda brachii as continuation of an arterial trunk arising from 3rd part of the axillary artery. This common trunk at its commencement passed between 2 roots of median nerve and gave branches of 3rd part of axillary artery before it continued as profunda brachii artery. The further course and branching pattern of profunda brachii were normal.Conclusion: Since the axillary artery is next choice of artery for arterial canulation in cardiopulmonary bypass procedures, prior knowledge of existence of such variation in its branching pattern helps in avoiding possible diagnostic or interventional therapeutic errors.Keywords: axillary artery, common trunk, profunda brachii, vascular variatio

A comparison of two molecular methods for diagnosing leptospirosis from three different sample types in patients presenting with fever in Laos.

OBJECTIVES: To compare two molecular assays (rrs quantitative PCR (qPCR) versus a combined 16SrRNA and LipL32 qPCR) on different sample types for diagnosing leptospirosis in febrile patients presenting to Mahosot Hospital, Vientiane, Laos. METHODS: Serum, buffy coat and urine samples were collected on admission, and follow-up serum ∼10 days later. Leptospira spp. culture and microscopic agglutination tests (MAT) were performed as reference standards. Bayesian latent class modelling was performed to estimate sensitivity and specificity of each diagnostic test. RESULTS: In all, 787 patients were included in the analysis: 4/787 (0.5%) were Leptospira culture positive, 30/787 (3.8%) were MAT positive, 76/787 (9.7%) were rrs qPCR positive and 20/787 (2.5%) were 16SrRNA/LipL32 qPCR positive for pathogenic Leptospira spp. in at least one sample. Estimated sensitivity and specificity (with 95% CI) of 16SrRNA/LipL32 qPCR on serum (53.9% (33.3%-81.8%); 99.6% (99.2%-100%)), buffy coat (58.8% (34.4%-90.9%); 99.9% (99.6%-100%)) and urine samples (45.0% (27.0%-66.7%); 99.6% (99.3%-100%)) were comparable with those of rrs qPCR, except specificity of 16SrRNA/LipL32 qPCR on urine samples was significantly higher (99.6% (99.3%-100%) vs. 92.5% (92.3%-92.8%), p <0.001). Sensitivities of MAT (16% (95% CI 6.3%-29.4%)) and culture (25% (95% CI 13.3%-44.4%)) were low. Mean positive Cq values showed that buffy coat samples were more frequently inhibitory to qPCR than either serum or urine (p <0.001). CONCLUSIONS: Serum and urine are better samples for qPCR than buffy coat, and 16SrRNA/LipL32 qPCR performs better than rrs qPCR on urine. Quantitative PCR on admission is a reliable rapid diagnostic tool, performing better than MAT or culture, with significant implications for clinical and epidemiological investigations of this global neglected disease

Oral rehabilitation with implant-based prostheses of two adult patients treated for childhood rhabdomyosarcoma

Background Rhabdomyosarcoma is the most common malignant tumor in the nasal and paranasal sinus area at childhood. Multimodal treatment for this disorder has severe side effects due to normal tissue damage. As a result of this treatment, facial growth retardation and oral abnormalities such as malformation of teeth and microstomia can cause esthetic and functional problems. Case reports Two cases are presented of patients with severe midfacial hypoplasia and reduced oral function as a result of treatment of rhabdomyosarcoma of the nasopharyngeal and nasal-tonsil region. With a combined surgical (osteotomy, distraction osteogenesis, implants) and prosthetic (implant-based overdenture) treatment, esthetics and function were improved

Expression of Mcm2, geminin and Ki67 in normal oral mucosa, oral epithelial dysplasias and their corresponding squamous-cell carcinomas

Proteins necessary for the normal regulation of the cell cycle include minichromosome maintenance protein 2 (Mcm2) and geminin. These are overexpressed in several premalignant and malignant tumours. The Mcm2/Ki67 ratio can be used to estimate the population of cells that are in early G1 (licensed to proliferate), and the geminin/Ki67 ratio can determine the relative length of G1. A high ratio indicates a short G1 and a high rate of cell proliferation. Mcm2 and geminin have been scarcely explored in oral epithelial dysplasia (OED) and oral squamous-cell carcinoma (OSCC). The purpose of this study was to identify the expression pattern of Mcm2, Ki67 and geminin in normal oral mucosa (NOM), OED and their subsequent OSCC, to determine if expression could help predict the prognosis of OED. Paraffin sections of 41 OED cases that progressed to carcinoma, 40 OED without malignant progression, 38 OSCC and 15 NOM were immunostained with antibodies against Mcm2, geminin and Ki67. Labelling indices (LIs) increased progressively from NOM, OED and OSCC (Mcm2, Po0.001; geminin, Po0.001 and Ki67, Po0.001). In all the OED cases (n ¼ 81) the levels of expression of Mcm2 (LI, 73.6), geminin (LI, 24.4) and Ki67 (LI, 44.5) were elevated indicating a constant cellcycle re-entry. When the OED groups were compared, Mcm2 protein expression was higher in the OED with malignant progression (P ¼ 0.04), likewise there was a significant increase in the Mcm2/Ki67 and geminin/Ki67 ratios (P ¼ 0.04 and 0.02 respectively). Mcm2 and geminin proteins seem to be novel biomarkers of growth and may be useful prognostic tools for OED

Colloids as Mobile Substrates for the Implantation and Integration of Differentiated Neurons into the Mammalian Brain

Neuronal degeneration and the deterioration of neuronal communication lie at the origin of many neuronal disorders, and there have been major efforts to develop cell replacement therapies for treating such diseases. One challenge, however, is that differentiated cells are challenging to transplant due to their sensitivity both to being uprooted from their cell culture growth support and to shear forces inherent in the implantation process. Here, we describe an approach to address these problems. We demonstrate that rat hippocampal neurons can be grown on colloidal particles or beads, matured and even transfected in vitro, and subsequently transplanted while adhered to the beads into the young adult rat hippocampus. The transplanted cells have a 76% cell survival rate one week post-surgery. At this time, most transplanted neurons have left their beads and elaborated long processes, similar to the host neurons. Additionally, the transplanted cells distribute uniformly across the host hippocampus. Expression of a fluorescent protein and the light-gated glutamate receptor in the transplanted neurons enabled them to be driven to fire by remote optical control. At 1-2 weeks after transplantation, calcium imaging of host brain slice shows that optical excitation of the transplanted neurons elicits activity in nearby host neurons, indicating the formation of functional transplant-host synaptic connections. After 6 months, the transplanted cell survival and overall cell distribution remained unchanged, suggesting that cells are functionally integrated. This approach, which could be extended to other cell classes such as neural stem cells and other regions of the brain, offers promising prospects for neuronal circuit repair via transplantation of in vitro differentiated, genetically engineered neurons