Variations in brachial plexus and the relationship of median nerve with the axillary artery: a case report

<p>Abstract</p> <p>Background</p> <p>Brachial Plexus innervates the upper limb. As it is the point of formation of many nerves, variations are common. Knowledge of these is important to anatomists, radiologists, anesthesiologists and surgeons. The presence of anatomical variations of the peripheral nervous system is often used to explain unexpected clinical signs and symptoms.</p> <p>Case Presentation</p> <p>On routine dissection of an embalmed 57 year old male cadaver, variations were found in the formation of divisions and cords of the Brachial Plexus of the right side. Some previously unreported findings observed were; direct branches to the muscles Pectoralis Minor and Latissimus dorsi from C6, innervation of deltoid by C6 and C7 roots and the origin of lateral pectoral nerve from the posterior division of upper trunk. The median nerve was present lateral to axillary artery. The left side brachial plexus was also inspected and found to have normal anatomy.</p> <p>Conclusion</p> <p>The probable cause for such variations and their embryological basis is discussed in the paper. It is also concluded that although these variations may not have affected the functioning of upper limb in this individual, knowledge of such variations is essential in evaluation of unexplained sensory and motor loss after trauma and surgical interventions to the upper limb.</p

Pathogens causing ventilator associated pneumonia and their antibiogram in a Tertiary Care Hospital in North Karnataka

Background: Ventilator associated pneumonia (VAP) is the most frequent intensive care unit acquired infection and is one of the leading causes of morbidity and mortality in ICUs. Objectives: To isolate and identify the causative organisms of ventilator associated pneumonia with their antibiotic susceptibility patterns in ICU patients of tertiary care hospital in North Karnataka. Methods: A prospective cohort study was conducted over one year period in ICUs of a tertiary care hospital in North Karnataka. ICU patients who were intubated and on mechanical ventilation for more than 48 hours, in whom VAP was clinically suspected {Clinical Pulmonary Infection Score (CPIS) > 6} were included in this study. Endotracheal aspirates and endotracheal tube tips after extubation were collected as samples. Quantitative culture threshold of more than 105cfu/ml was considered as diagnostic of VAP. Fifty one isolates were obtained from 47 samples as mixed growth was seen from 4 samples. Results: The incidence of VAP in our study was 47.00%. The most common isolates were Pseudomonas aeruginosa (31.38%), Staphylococcus aureus (27.46%), Acinetobacter (11.76%) and Escherichia coli (11.76%). Most of the gram negative bacteria isolated were sensitive to Imipenem and Cefoperazone - sulbactum and gram positive bacteria were sensitive to Vancomycin. Conclusion: The sensitivity patterns of gram negative bacteria and gram positive bacteria vary according to the ICU and the population studied. The recovery rate (78.94%) was higher in the early onset VAP cases. Late onset VAP had higher mortality (64.28%) when compared to the early onset VAP group (21.05%)

Anatomical Variations of the Temporomesial Structures in Normal Adult Brain - A Cadaveric Study

Background: Despite significant evolutional, functional, and clinical interest, the anatomical variations of the temporomesial structures in cadaveric samples have received little attention. This study was undertaken to document the anatomical variations observed in the temporal lobe of human brain with emphasis on the structures present in temporomesial region. Materials and Methods: Using 26 postmortem cadaveric cerebral hemispheres (13 right and 13 left hemispheres), several neurosurgically significant mesial structures were studied by blunt dissection under the operating microscope. The observed surface-based qualitative variations and right-left asymmetries were tabulated under well-defined, moderately defined, and ill-defined classification. Results: Among the areas, uncus (100%), limen insulae (88.4%), rhinal sulcus and hippocampus (81%), intralimbic gyrus (77%), Heschl's gyrus (73%), gyrus ambiens, semilunar gyrus, sulcus semiannularis, and calcar avis (69.2%) were well defined, and band of Giacomini (38.4%) was found to be distinctly ill-defined areas in the list. Further, our analysis confirmed the presence of consistent left-greater-than-right asymmetry in all the areas of interest in temporal region under well-defined category. Rightward asymmetry was noticed in moderately defined and ill-defined classification. However, no asymmetry was detected in the uncal region. P value for all the obtained results was >0.05. Conclusion: Our study offers a preliminary anatomic foundation toward the better understanding of temporal lobe structures. These variations may prove valuable to neurosurgeons when designing the appropriate and least traumatic surgical approaches in operating the temporomesial lesions

Dermatoglyphics in rheumatoid arthritis

Patients with rheumatoid arthritis have been referred to Division of Human Genetics for counselling. Qualitative dermatoglyphics comprising of finger print pattern, interdigital pattern, hypothenar pattern and palmar crease were studied on 26 female and 11 male rheumatoid arthritis patients. Comparison between patient male and control male; and patient female and control female has been done. 'Chi' square test was performed. In male patients, with hands together, arches were increased, loops/whorls were decreased. Partial Simian crease was significantly increased. In the right hand, patterns were increased in the 3rd interdigital area. On the other hand, in female patients there was a significant increase in whorls and decrease in loops on the first finger on both the hands, increase in arches on the 3rd finger; both arches and whorls on the 4th finger of left hand. Present study has emphasized that dermatoglyphics could be applied as a diagnostic tool to patients with rheumatoid arthritis