Etanercept decreases synovial expression of tumour necrosis factor-α and lymphotoxin-α in rheumatoid arthritis

OBJECTIVES

Etanercept is an effective tumour necrosis factor (TNF)-α inhibitor drug with the unique ability to block not only TNF-α but also lymphotoxin (LT)-α, at least in vitro. We aimed to investigate the in vivo effect of etanercept on synovial expression of TNF-α and LT-α.

METHOD

Synovial biopsies from 12 rheumatoid arthritis (RA) patients started on etanercept and 11 RA patients started on infliximab were obtained at baseline and 8 weeks after treatment initiation. Synovial expression of TNF-α and LT-α was evaluated by immunohistochemistry followed by computer-assisted image analysis. Differences between paired samples were analysed by the Wilcoxon test and between groups by the Mann-Whitney test. A p-value < 0.05 was considered statistically significant.

RESULTS

Six out of the 12 of the patients started on etanercept achieved an American College of Rheumatology (ACR)50 response. Macroscopic evaluation of the joints during arthroscopy revealed a significant decrease of local inflammation mainly in good ACR50 responders. Synovial expression of both LT-α and TNF-α decreased but the differences did not reach statistical significance at a group level. By contrast, a significant decrease in both LT-α and TNF-α was observed when only good ACR50 responders were analysed. Despite higher levels of baseline synovial TNF-α in the good responders, neither baseline LT-α nor TNF-α could predict clinical response after 8 weeks. A decreasing trend of the synovial levels of LT-α was also observed in good responders to infliximab, but the difference did not reach statistical significance.

CONCLUSIONS

Etanercept treatment modulates the synovial expression of both TNF-α and LT-α in vivo, a mechanism that might partly explain its clinical efficacy in RA.

Effect of sildenafil-induced nitric oxide on the histomorphology of cardiomyocytes in male rats

Introduction:

Although sildenafil citrate, one of the selective phosphodiesterase-5 (PDE5) inhibitors, is considered the best treatment for erectile dysfunction, studies have shown that it has also a beneficial effect on a variety of cardiovascular conditions. In spite of reports of a significant protective effect of sildenafil against necrosis in intact hearts, there are also contradictory reports regarding its beneficial effect on the heart. Since there are not enough reports regarding the histomorphological changes in the cardiomyocytes after exposure to sildenafil citrate, the present study was conducted to observe the same along with other biochemical parameters.

Materials and Methods:

Adult male albino rats of Wistar strain were used in the present study. The animals were divided into a control group and two experimental groups containing six rats each. The animals were treated with a solution of sildenafil citrate dissolved in distilled water. Histomorphological changes were observed by light microscopy and the levels of nitric oxide (NO) and PDE in the heart were measured by spectrophotometry.

Results:

It was observed that animals treated with sildenafil citrate showed a highly significant increase in NO and a decrease in PDE level, but the histological architecture of the cardiomyocytes did not show much change other than a slightly elongated and swollen nucleus.

Conclusions:

This study shows that sildenafil citrate at low dosage is well tolerated by cardiac muscle cells, but as dosage increases, it may become detrimental through its NO and PDE activity.

Bilateral arterial variation in the upper extremity--an anatomical case report

We report a case of bilateral arterial variation in the upper extremities of a male cadaver. In the left upper extremity, it was observed that the ulnar artery was arising from axillary artery. This ulnar artery was superficial throughout its course at the medial aspect of the arm and forearm. It was highly tortuous and did not have any branches either in the arm or forearm. It ended as the superficial palmar arch in the palm. However the brachial artery entered the cubital fossa and divided into radial and common interosseus arteries. In contrast, the right upper extremity was having normal brachial artery which was terminated into the ulnar and radial arteries at the cubital fossa. However, there was an accessory brachial artery present at the arm and ended at the cubital fossa. We believe that these anatomical variations are because of abnormal developmental vascular pattern in the region. In clinical practice, accurate knowledge of the arterial variations of upper extremity is of considerable importance in case of reparative surgeries and fracture management. They are of interest to the vascular and plastic surgeons.

Incomplete discoid lateral meniscus: a case report

The variations of lateral meniscus include pathologic entities which vary in size, shape and attachment. In this manuscript, we report a case of discoid lateral meniscus which was observed in an embalmed fetal cadaver. It was an incomplete variety of the discoid meniscus and observed on the right side knee. The clinical implication of this discoid meniscus has been emphasized along with the review of literature. The morphological and embryologic details of the discoid lateral menisci are discussed.

Morphological analysis and morphometry of the foramen magnum: an anatomical investigation

AIM

The objectives were to study the morphology of the foramen magnum in dry skulls and to evaluate its antero-posterior diameter, transverse diameter and the foramen magnum index.

MATERIAL AND METHODS

The foramen magna of 53 dry human cadaver skulls that were obtained from the neuroanatomy laboratory were examined. Different shapes of the foramen magnum were macroscopically noted and classified. The antero-posterior and transverse diameters were measured and the average foraminal index was calculated.

RESULTS

The foramen magnum shapes were determined as a round shape in 22.6% of cases, egg shape in 18.9%, tetragonal in 18.9%, oval in 15.1%, irregular in 15.1%, hexagonal in 5.6% and pentagonal in 3.8% of the cases. In 20.7% of skulls, the occipital condyle was observed to protrude into the foramen. The mean antero-posterior and transverse diameter of the foramen magnum was determined as 31 ± 2.4 mm and 25.2 ± 2.4 mm respectively. The average foramen magnum index was 1.2 ± 0.1.

CONCLUSION

The present study has determined the various shapes of foramen magnum and its morphometry. The data obtained may be of useful to the neurosurgeon in analyzing the morphological anatomy of craniovertebral junction. The findings are also enlightening for the anthropologists, morphologists and clinical anatomists.

Bone morphometry

OBJECTIVES

To compare anatomical measurements with that of radiological measurements.

BACKGROUND

The radiological measurements are commonly used in clinical practice. It is well known that the anatomical measurements are more accurate than radiological. The comparison of anatomicoradiological measurements is not reported hitherto.

METHODS

One human adult cadaveric femur bone was used for the present study. It was measured both anatomically and radiologically.

RESULTS

In digital X- ray measurements, the length from the upper lip of fovea capitis to the most prominent part of greater trochanter was 87.2 mms, from the upper most part of greater trochanter to the isthmus it was 147.9 mms, mediolateral width of medullary cavity at the isthmus was 8.9 mms, the mediolateral width at the distal root of lesser trochanter was 18.5 mms, anteroposterior width of medullary cavity at the isthmus was 11.5 mms, the anteroposterior width at the distal root of lesser trochanter was 16.8 mms. The same measurements were 91.2 mms, 154.6 mms, 11.8 mms, 19.7 mms, 11.9 mms and 18.5 mms when taken anatomically using the digital vernier caliper.

CONCLUSION

The present study showed that in all the parameters measured the radiological values were slightly lesser than the anatomical values. Considering the variations in the values, the implants can be designed for a particular case in orthopedic surgery. We believe that this study adds an important reference in the scientific literature (Tab. 1, Fig. 2, Ref. 5).

Clinically oriented morphometric study of medial and lateral menisci of the knee joint in adult cadavers

PURPOSE

The objective was to analyze the peripheral and inner border lengths of the medial and lateral menisci and the distance between anterior and posterior horns.

MATERIALS AND METHODS

The menisci from 23 adult knee joints (46 menisci) of the formalin fixed cadaver lower limbs were used. The peripheral and inner borer lengths of the menisci were measured with a non elastic cotton thread and the distance between the horns were measured with the vernier caliper of 0.02 mm accuracy.

RESULTS

The mean peripheral lengths of the medial and lateral menisci were 99.06 +/- 11.21 and 90.25 +/- 9.36 mm respectively. The inner border lengths for the same were determined as 55.44 +/- 8.37 and 50.63 +/- 5.33 mm respectively. The distances between the anterior and posterior horns were 24.13 +/- 4.19 and 11.31 +/- 3.86 mm for the same. The peripheral length and inter horn distance of the medial meniscus was more than the lateral, the statistically significance was observed (*p<0.05). The other parameters obtained were statistically not significant.

CONCLUSION

The present study had determined some important anatomical data which may be of importance to the orthopaedic literature. The findings are also enlightening for the anthropologists and clinical anatomists.

A morphometric study of foramen ovale

AIM

To note the morphological variations and morphometric details of foramina ovale in dry adult skulls of Indian origin.

MATERIAL AND METHODS

82 dry adult human skulls of unknown sex and of Indian origin were obtained and variations in appearance and number of foramen ovale were noted. The length and width of the foramina ovale of both sides were determined using digital Vernier calipers and area (A) was also calculated and analyzed.

RESULTS

Out of 82 adult skulls, the values for the right side was 7.64 ± 1.194 mm, 5.128 ± 0.827 mm and 30.808 ± 7.545 mm2 and for the left side the values was 7.561 ± 1.123 mm, 5.244 ± 0.950 mm and 31.310 ± 8.262 mm2 respectively, for the mean length, width and area of the foramen ovale. The shape of foramen was typically ovale in most of the skulls (56.70%) with some bony variations such as spine, tubercles etc.

CONCLUSION

There was no statistically significant difference between the two sides in length, width and area of foramen ovale and there was a positive correlation between lengths and areas of both sides.

K. COMMUNICATION BETWEEN THE MUSCULOCUTANEOUS AND MEDIAN NERVE: OCCURRENCE ON BOTH SIDES

Communications between musculocutaneous nerve and median nerve may be of considerable significance to neurologists and orthopaedicians when dealing with patients of nerve entrapment syndromes of the upper limb. Many authors have mentioned about an occurrence of such a variation previously, but the presence of a communication between the two nerves in both the arms has not been cited to the best of our knowledge. During routine dissection on a 72 year old male cadaver for the under graduate students in the Department of Anatomy at K.S. Hegde Medical Academy, we encountered an anomalous communication between musculocutaneous and median nerve in both the upper limbs. The communicating branch arose from the musculocutaneous nerve at a distance of 12.6 cm and 12.5 cm from the tip of coracoid process on right and left side and joined the median nerve 16.2 cm from the same bony point. Communications between nerves like this may explain abnormal debilities in certain cases of trauma of the upper arm. Lack of awareness of such variations with different patterns of communications between musculocutaneous and median nerve might complicate surgical repair of the nerves.

Morphometric analysis of clavicle in nepalese population

BACKGROUND

Determining the sex of deceased is easy when a complete skeleton is available for examination. On the whole, the bones are heavier, larger and markings of muscular attachments are more pronounced in the male than in the female.

OBJECTIVE

The purpose of this study was attempted to evolve an easily applied formula to enable the assessment of sex in an unknown clavicles and to know about comparative differences between the right and left clavicles, from certain metrical parameters.

METHODS

The study was an observational, cross-sectional and descriptive in nature. The present study was conducted on 257 adult clavicles out of which, 135 were of the right side and 122 of left side. The maximum length of the clavicle (in mm) was taken.

RESULTS

The length of the right clavicles varies from 108 mm to 178 mm with an average of 143.21 mm ± 11.13 mm S.D. The length of the left clavicles varies from 111 mm to 181 mm with an average 145.53 mm ± 11.04 mm S.D. It has been observed that the left clavicle was longer than the right clavicle by 2.32 mm. There was no such single character which can determine the sex of all clavicles. Depending on the length alone, the sex can be decided in 13.33% male and 4.44% female right clavicles and 16.39% male and 9.83% female bones if the left clavicle is considered.

CONCLUSION

The left clavicle was longer than the right clavicle. The determination of sex from the clavicle has a great medico legal significance to the toxicologists. It also helps the anthropologists in their study of evolution of mankind and migration of races.

Aberrant deep flexor muscles of the forearm associated with the accessory origin of first lumbrical muscle

Objective

To find out variations in the deep forearm flexors that are associated with anomalous origin of the first lumbrical muscle.

Introduction

Muscular anomalies of the upper extremity could cause peripheral nerve disorders. Although variations in the attachments of lumbrical muscles have been commonly studied, muscle with an additional origin in the proximal aspect of the forearm from the deep flexors is not much discussed.

Methods

Fifty-three formalin-fixed upper limbs were dissected to assess the aberrant origin of the first lumbrical from the deep forearm flexors. The measurement, shape, origin, insertion and innervation of aberrant deep forearm flexors were noted and photographed.

Results

In two (3.77%) out of 53 upper limbs unilateral aberrant deep forearm flexors were found giving accessory anomalous origin to the first lumbrical muscle. In 11 cases (20.75%) the presence of accessory head of flexor pollicis longus was seen, and found co-existing with the aberrant deep forearm flexor in one (1.89%) limb.

Discussion

The clinical implication of these muscular anomalies, such as aberrant origins and hypertrophy of the first lumbrical, in nerve entrapments, especially in the aetiology of carpal tunnel syndrome, is considered. The awareness and identification of the muscular variations of the antebrachial and carpal regions will facilitate safe surgery of cases of median nerve entrapment syndromes.

Foramina on the zygomatic bone: its clinical significance

AIM

To study the anatomy of zygomatico-orbital, zygomatico-facial and zygomatico temporal foramina in south Indian population.

MATERIALS AND METHODS

50 dry adult skulls of south Indian origin were studied. The number of ZO, ZF and ZT were recorded on each side. The distances of these foramina to the nearest palpable bony points, infero-lateral angle of the orbit and infra-orbital foramen were measured using Vernier's calipers.

RESULTS

Variable number of ZO and ZF foramina, ranging from 0 to 4 was seen. Single ZO foramen in 56% and 44%, double in 6% and 12%, absent in 38% and 44% on right and left sides were seen. Distance of ZO foramen from inferolateral angle of orbit was 9+2.51 mm and 7.8+1.74 mm on right and left side respectively. The mean distance from infraorbital foramen was 29.93+2.76 mm and 30.19+ 3.52 mm on right and left side respectively. Single ZF foramen in 40% and 42%, double in 10% and 8%, 3 in 4% on right side and 4 in 2% on left sides were seen. In the remaining 46% and 48% of bones, the ZF foramen was absent. Mean distance from inferolateral angle of orbit was 8.05+2.68 and 9.15+2.11 mm respectively on the right and left side. Mean distance from infraorbital foramen was 25.45+4.35 mm and 25.42+4 mm respectively on right and left side.

CONCLUSION

The location of ZO and ZF foramen can be population specific and knowledge of its location is important during stabilization of zygomatic fractures, in endoscopic subperiosteal facelift.

Bilateral anomaly of rectus capitis posterior muscles in the suboccipital triangle and its clinical implication

Rectus capitis posterior muscles are located in the suboccipital triangle and function in extension and lateral rotation of the head and neck. There are two of these muscles on each side: the rectus capitis posterior major and the rectus capitis posterior minor. In the present case we observed bilateral double rectus capitis posterior major muscle and bilateral absence of rectus capitis posterior minor muscle. The additional rectus capitis posterior major may put more strain to the spine of the axis and mean time the bilateral absence of rectus capitis posterior minor muscles will result in muscular in coordination in the suboccipital region while balancing the head. The present variation should be considered in the aetiology of cervicogenic headache.

Prediction of postoperative pulmonary reserve in lung resection patients

We performed Ventilation/Perfusion scans for patients planned for thoracotomy with resection of the primary or metastatic lung tumors. We predicted the post-operative FEV1 (Forced Expiratory Volume in first second) using Differential Lung Analysis software.

METHODS

34 patients were evaluated with Ventilation/Perfusion (V/Q) scans. Ventilation scan was performed with Tc-99m DTPA Aerosol and Perfusion Scan with Tc99m MAA, on 2 different days. The numbers of counts in anterior and posterior views of V/Q scans were calculated individually. Anterior and posterior arithmetical mean was calculated and post-operative FEV1 was predicted with the use of Differential Lung Analysis software. In most of the patients, the counts in the ventilation scan were lower and they were related to preoperative FEV1. Depending on the volume of lung resection, i.e. Upper, Middle and Lower zones or Total Pneumonectomy, FEV1 was calculated. Whenever FEV1 was >0.8 (L), the patient was taken up for resection (and if there were no other risk factors, such as cardiac complications, chronic obstructive pulmonary diseases, and any other pathological conditions involving the contralateral lung).

RESULTS

Most of the 34 patients were taken up for lung resection based on our FEV1 predictions. In 7 patients, repeat spirometry (i.e. pulmonary function test) was done at varying intervals after surgical procedures and the variation between preoperative FEV(1) and postoperative FEV(1) was only ±15%, at the most.

CONCLUSION

Postoperative FEV(1) based on V/Q scan and pulmonary function tests helped us to proceed with lung resection after assessment of the pulmonary reserve.