Bilateral high division of sciatic nerve

Sciatic nerve is the thickest nerve in the body formed by the sacral plexus from L4 to S3 in the lesser pelvis. It emerges through the greater sciatic foramen below the piriformis and enter the gluteal region. Then the nerve passes on the back of the thigh and at the level of superior angle of popliteal fossa it terminates by dividing into tibial and common peroneal nerve. The knowledge of anatomical variations in the division of nerve is important for various surgical and anaesthetic procedures. During routine dissection in the department of anatomy, Mysore Medical College & Research Institute, Mysore, a rare bilateral high division of sciatic nerve was observed in a female cadaver aged about 40 years. In the present case there was bilateral high division of sciatic nerve. The nerve was seen dividing into two branches before it emerges through the greater sciatic foramen. The tibial nerve was entering the gluteal region below the piriformis muscle and common peroneal nerve was entering by piercing the piriformis. The knowledge of this variation is important as the nerve may get compressed with surrounding anatomical structures resulting in non discogenic sciatica. The awareness of variations is important for surgeons during various procedures like fracture, posterior dislocation of hip joint and hip joint replacement. The anatomical variations are important during deep intramuscular injections in gluteal region and also for anaesthetists during sciatic nerve block

Situs inversus

Situs inversus is a rare condition with a genetic predisposition, where in organs are transposed from their normal location to the opposite side of the body with an incidence of 1 in 10000 live births. If Situs Inversus is associated with other congenital anomalies the survival rate is low. So prenatal diagnosis is essential to detect any associated anomalies. During routine fetal autopsies conducted in the department of anatomy, Mysore medical college, Mysore, a rare interesting case of still born baby with gestational age of 20 weeks was observed. Autopsy findings of external examination revealed kyphosis in thoracic region. Thoracotomy revealed heart on the right side (dextrocardia). Laparotomy revealed that the left lobe of liver was bigger than the right. The gall bladder was present on the visceral surface of the left lobe of liver, stomach was on right side, duodenum on left side, pancreas and spleen were on the right side. There was agenesis of right kidney, right ureter and both suprarenal glands. All the above findings correlate with the condition situs inversus. Situs inversus is a rare condition with a genetic predisposition, it’s etiology lies in the mutation of chromosome no 12, which is critical for recognition of right sidedness.1,2 Even though there is transposition of organs in situs inversus, the survival rate is good but if situs inversus is associated with other congenital anomalies the survival rate is low. So prenatal diagnosis is essential to detect any associated anomalies to bring down mortality rate

Morphological variations of the thyroid gland

Background:The knowledge of various morphological & developmental anomalies of thyroid gland will help the surgeons in better planning of safe & effective surgery. Considering these facts we studied the variations of thyroid gland.Methods:The material for the present study was collected from the department of forensic medicine, MMC & RI, Mysore, which includes 56 male and 33 female adult postmortem cadavers aged between 18 to 80 years. A dissection was carried out to expose thyroid glands & variations were observed in the morphology of thyroid gland.Results: 1) 9% of specimens had agenesis of isthmus. 2) 46% of specimens had pyramidal lobe. 3) 41% of specimens had levator glanduli thyroidae. 4) 2.24 % of specimens had accessory thyroid tissue.Conclusion:This study highlights the various morphological anomalies of the thyroid gland which forms cornerstone to safe & effective surgery

Congenital malformations in multiple births

Objective: The present study was done to know and compare the incidence of congenital malformations in singleton and multiple births in our hospital & compare with other studies.Methods: A retrospective study done by collecting the data from parturition register from Jan 2008 to Dec 2011 (4yrs) from Cheluvamba Hospital attached to Mysore Medical College and Research Institute. Total number of the live births, still births, and abortions> 20 wks were collected. Details of multiple births such as maternal age, gestational age, sex & birth weight of the babies, U/S reports and congenital anomalies (CA) were noted.Results: The total number of singleton births were 48700 and number of babies who had congenital malformations were 235 (48.25/10,000 births).Total number of multiple births were 579 including 10 triplets and number of babies who had CA were 11 (189.98/10,000 births, P<0.0001). In the present study sex of the babies were noted in all multiple births and zygosity could not be recorded. Among 579 multiple births 404 were of the Same Sex (SS) and 165 were of Opposite Sex (OS) in twins and 6 were of the same sex and 4 were of opposite sex in triplets. According to Weinberg formula 50% of same sex (SS) twins are monozygotic and 50% are dizygotic twins. Among the 11 babies with CA, 4 monozygotic twins had anomalies related to twinning such as Acardia with TRAP sequence (3 twins), and Thoracophagus (1 twin).5 babies had CNS anomalies, 1 with cystic hygroma, 1 baby with multiple system affected.Conclusion: The incidence of birth defects is more in multiple births and especially in monozygotic twins. In the present days increase in twinning rate due to advanced maternal age, hereditary factors and use of ovulation inducing drugs, which results in premature and low birth wt babies associated with poor lung maturity

Evaluation of the effects of tramadol and diclofenac alone and in combination on post-cesarean pain

Background: Post-cesarean pain is a common cause of acute pain in the obstetrics. Pain in the postoperative period is an important impediment to recovery from surgery and anesthesia. This study was conducted to evaluate the efficacy of postoperative analgesia and incidence of side-effects of centrally acting drug tramadol with peripherally acting drug diclofenac alone and in combination in patients undergoing elective cesarean delivery under spinal anesthesia.Methods: The study population of 90 patients was randomly divided into three groups of 30 each to receive the following treatments: tramadol (Group T), diclofenac (Group D), tramadol and diclofenac at reduced doses (Group TD).Results: Combination of tramadol and diclofenac produced significantly early analgesia in comparison to tramadol or diclofenac alone and decrease in the incidence of side-effects.Conclusion: We conclude that a multimodal approach to post-cesarean management with a combination of tramadol and diclofenac produced better analgesia than individual drugs and a reduction in the side-effects. Such a combination approach to relieve pain is more effective and advantageous

A two-codon mutant of cholera toxin lacking ADP-ribosylating activity functions as an effective adjuvant for eliciting mucosal and systemic cellular immune responses to peptide antigens

Abstract Vaccination with peptide antigens is an effective strategy against mucosal viral infections. We tested a two-codon mutant of cholera toxin (CT-2*) lacking ADP-ribosylating activity and toxicity as a mucosal adjuvant for T cell epitope peptides for intranasal immunization of mice. Efficient induction of helper and cytotoxic T lymphocyte responses associated with TH1 cytokine production were observed in the systemic and mucosal compartments including nasal, gut, and vaginal associated lymphoid tissues. Single or multiple dosing with the peptide antigen and CT-2* induced strong memory immunity without tolerance. These results demonstrate CT-2* as a suitable mucosal adjuvant for priming antigen-specific cellular immune responses

Ornithine α-ketoglutarate modulates the levels of antioxidants and lipid peroxidation products in ammonium acetate treated rats

422-424The effects of ornithine α-ketoglutarate (OKG) on ammonium acetate induced hepatotoxicity were studied in experimental rats. The levels of urea, non-protein nitrogen and thiobarbituric acid reactive substances were significantly increased in ammonium acetate treated rats ; but these levels were significantly decreased in ammonium acetate-OKG treated rats. Similar patterns were observed in the levels of free fatty acids, triglycerides and phospholipids. Furthermore, non-enzymatic (reduced glutathione) and enzymatic (glutathione peroxidise, superoxide dismutase and catalase) antioxidants were significantly decreased in ammonium acetate treated rats. When compared with control and were significantly increased in ammonium acetate-OKG treated rats compared to ammonium acetate treatment alone

Study - A study of serum nitric oxide levels in psoriasis

BACKGROUND: Many inter and intracellular mediators have been implicated in the pathogenesis of psoriasis. Nitric oxide has been shown to play an important role in many diseases. Previous studies have demonstrated raised levels of nitric oxide in psoriatic plaques which may be attributed to its effect on keratinocytes, on local cGMP levels or its ability to induce angiogenesis. AIMS: To detect serum nitric oxide (NO) levels in patients with active psoriasis, to correlate these levels with severity of disease and compare them with those in normal individuals. METHODS: Thirty six patients with active psoriasis were selected after written consent. All patients on topical or systemic treatment for fifteen days prior to the study were excluded. Disease severity was assessed by PASI score and serum nitric oxide levels were detected by Greiss method and compared with age and sex matched controls. Statistical analysis of all data was done by unpaired t test. RESULTS: Out of 36 patients, 30 had chronic plaque psoriasis (mean NO 157.5), 4 had erythroderma (mean NO 120.2) and 2 had generalized pustular psoriasis (mean NO 144.3). The mean NO level in the psoriatic group was 157.7 with SD 50.4 while in the control group it was 32.8 with SD 4.03. The difference was statistically significant (t=13.8, P <0.001). In the chronic plaque group, as the duration of disease increased, the NO levels increased significantly. CONCLUSIONS: Nitric oxide levels were significantly increased in patients with psoriasis and these levels showed a positive correlation with severity and duration in the chronic plaque type group