A rare case of bilateral sternocleidomastoid muscle variation

An abnormal sternocleidomastoid (SCM) muscle was encountered bilaterally during routine dissection of the head and neck region of a 60 year old male cadaver. The SCM muscle of both the sides had an additional sternal head arising from the capsule of the sternoclavicular joint and the supero-lateral border of the manubrium sterni. The clinical significance of the present variation is immense, as it might cause difficulty in assessing the vital neurovascular structures of the neck during surgical procedure.

Circulus arteriosus cerebri: a study of variation in the fetal and adult human brains of south Indians

The Circle of Willis or Circulus Arteriosus Cerebri and its branches are subject to many variations. The Circle of Willis with a classical description is very rare. The constituent arteries forming the circle vary greatly in size in different individuals and on two sides in the same subject. Study by dissection or by angiographic methods by several workers has shown that deviations from the normal pattern occur in a very high proportion of cases. There are differing views regarding the variations in the circle. Thus, this study was done to compare our findings with the others. In the present study, each artery taking part in the circle has been described in relation to the length, size and its origin separately and the findings have been compared.

An unusually lengthy styloid process

The close proximity of the styloid process to many of the vital neurovascular structures in the neck makes it clinically significant. Abnormal elongation of the styloid process may cause compression on a number of vital vessels and nerves related to it, producing inflammatory changes that include continuous chronic pain in the pharyngeal region, radiating otalgia, phantom foreign body sensation (globus hystericus), pain in the pharyngeal region, and dysphagia. The normal length of the styloid process is usually 2.0-2.5 cm long. We report a dry human skull that showed bilateral styloid processes measuring 6.0 cm on the right side and 5.9 cm on the left side. The variation in dimension of the process and its clinical implication are discussed.

Population distance between Dakshina Kannada (South India) and Gujarati (North India) population using infracranial nonmetric traits

Infracranial nonmetric variations have been considered for determining population distance between different regions and continents, in recent times. We studied different infracranial nonmetric traits from the Dakshina Kannada (South India) region to compare with the data available from the Gujarati (North India) region. The mean measure of divergence between the two different geographic regions showed significant variation. In our study, the incidence like i) Allen's fossa of the femur, ii) plaque formation in the upper end of the femur, iii) exostosis in trochanteric fosse of femur, iv) third trochanter of femur, v) os trigonum of talus, vi) medial talar facet, vii) peroneal tubercle of calcaneus, viii) bipartite transverse foramen in the cervical vertebra, too showed significant side difference.

Multiple anomalies involving testicular and suprarenal arteries: embryological basis and clinical significance

Variations in the origin of arteries in the abdomen are very common but with the invention of new operative techniques within the abdominal cavity, the anatomy of abdominal vessels has assumed much more clinical importance. During routine dissection of the abdominal cavity, we came across multiple arterial anomalies involving testicular and suprarenal arteries. On the right side, there was double testicular artery (medial and lateral) and the right inferior suprarenal artery aroused from the medial testicular artery. The right inferior phrenic artery (IPA) and middle suprarenal artery took origin from a common trunk just above the origin of right renal artery (RRA). On the left side, the left testicular artery was arching over the lower tributary of the left renal vein proper (LRVP). Apart from the developmental and morphological interest in arching gonadal arteries, they are of practical importance from a clinical and surgical viewpoint. The embryological and clinical significance of above variations has been described.

Anomalous channels draining the internal iliac veins: embryological and clinical significance

During a routine cadaver dissection, we have encountered an anomalous formation of inferior vena cava and abnormal channels communicating the two internal iliac veins with the inferior vena cava in a 67 year old male cadaver. The said channels which had a caliber of 5 mm on the left side and 15 mm on the right arose at a distance of 26 mm on the left and 35 mm on the right from the internal iliac vein termination. Both the said channels moved medially and joined one another and formed a common stem (Cs) which finally terminated at the junction of the termination of right iliac vein into the inferior vena cava. The lumen of the terminal part had a diameter of 18 mm and it was 20 mm in length. Anomalies of the inferior vena cava and renal veins occur infrequently but if unidentified can lead to significant morbidity during surgical exploration. An understanding of the embryologic development of the vena cava and its tributaries is necessary to understand the genesis of these sometimes complex anomalies and their accompanying anatomic variants.

Clinical significance of a mysterious clival canal

During routine osteology demonstration of the posterior cranial fossa we noticed a transverse bony canal in the middle third of the clivus of an adult male skull. The canal was situated 1.8 cm in front the anterior border of the foramen magnum. The length of the canal was 0.6 cm long. The possible embryological basis and clinical significance of the variation was discussed.

Arcuate foramen of atlas: incidence, phylogenetic and clinical significance

Arcuate foramen is less known trait of the human atlas vertebra formed by a delicate bony spiculum, which arches backward from the posterior end of the superior articular process. Examination of 1044 human atlas vertebra revealed that the trait was present in 13.8% of the samples. The mean length of the arcuate foramen form was 7.16 mm on the left side and 9.99 mm on the right side in bilateral positive samples while it was 8.14 mm and 9.26 mm respectively in unilateral positive samples. The mean vertical height of this foramen was 6.57 mm on the left side and 6.52 mm on the right side in bilateral positive samples while it was 4.91 mm and 5.38 mm respectively in unilateral positive samples. The sides did not show any statistical significant differences. The importance of the arcuate foramen lies in the external pressure it may cause on the vertebral artery as it passes from the foramen transversarium of the first cervical vertebra to the foramen magnum of the skull.

Breast conservation treatment in women with locally advanced breast cancer - experience from a single centre

INTRODUCTION

In absence of randomized evidence to support safety of conservative surgery (BCT) in locally advanced breast cancer (LABC), we analyzed a cohort of 664 women with LABC treated during January 1998 to December 2002 at Tata Memorial Hospital, Mumbai, India.

MATERIALS AND METHODS

All were treated with a multimodality regimen comprising of neoadjuvant chemotherapy (NACT) followed by surgery (modified radical mastectomy or BCT) and adjuvant radiotherapy and hormone therapy. The outcome was evaluated to assess safety of BCT.

RESULTS

71% (469/664) women responded to NACT (22% clinical CR and 49% PR) and 28.3% (188/664) underwent BCT. Positive lumpectomy margins were reported in 8.5%, with gross presence of tumor at the margins in 2.3% requiring a revision surgery. At a median follow-up of 30months, local relapse rate was 8% after BCT and 10.7% after mastectomy. The 3-year local DFS was better post-conservation than after mastectomy (87% vs 78%, P=0.02). The disease-free survival (DFS) was also superior after BCT, 72% vs 52% (P<0.001) at 3years and 62% vs 37% (P<0.001) at 5years respectively. On multivariate analysis, presence of lymphatic vascular emboli (LVE) was the major significant predictor of local recurrence (P<0.001, HR 2.52, 95% CI 1.52-4.18). DFS was better after BCT [(P<0.001, HR 2.0 (95% CI 1.38-2.91)]; shorter DFS was noted in LVE positive (HR 1.54, P=0.007) and larger residual disease after NACT (HR 1.13, P=0.001).

CONCLUSION

BCT is technically feasible and safe post neo-adjuvant chemotherapy in women with LABC with no detriment in outcome.

Comparison of pyrazinamide drug susceptibility of M. tuberculosis by radiometric BACTEC and enzymatic pyrazinamidase assay

The aim of this study was to perform pyrazinamide (PZA) susceptibility testing of M. tuberculosis by enzymatic PZA assay and compare the results with radiometric BACTEC 460 TB system and LJ proportion method. One hundred and thirty clinical isolates of M. tuberculosis were included in the study. Of the 130 clinical isolates tested, five were resistant and 124 were sensitive by both methods thus giving overall sensitivity and specificity of 83.33% and 100% respectively. Concordance was found in 129 out of 130 strains tested by all three methods. Pyrazinamidase assay can be used as an alternative to BACTEC and LJ proportion method.

Relaxed acceleration tolerance in female pilot trainees

BACKGROUND

Female pilots now fly many types of aircraft including military fighters capable of maneuvers that produce high, sustained acceleration in the +Gz axis. Although women have participated as subjects in various centrifuge studies, little is known about the acceleration tolerance of female pilots.

METHODS

Between April 1995 and December 1997, 17 female pilot trainees were studied at the Institute of Aerospace Medicine, Bangalore, India. The subjects were 23.2 +/- 1.4 yr old and led physically active lives. Their relaxed +Gz tolerance limits (defined as peripheral light loss) were tested using the High G and Disorientation Demonstrator. The protocol included a series of rapid onset runs (RORs) to tolerance followed by a single gradual onset run (GOR) to tolerance.

RESULTS

The mean ROR tolerance was 4.2 +/- 0.4 G. The mean GOR tolerance was 5.2 +/- 0.6 G. Three of the subjects were unable to complete the GOR due to severe nausea. Two women reported breast discomfort at levels of 3.5 G and beyond. No other problems were reported.

CONCLUSIONS

The acceleration tolerances for the female pilot trainees were comparable to those for male pilots previously studied in our laboratory.

Rapid detection of rifampicin resistance in M. tuberculosis by phage assay

Increase in multidrug-resistant M. tuberculosis (MDR-TB) has become a great cause of concern and rifampicin resistance is considered to be a good predictor of MDR-TB in many parts of the world. Its rapid detection will allow alteration in treatment regimens in time to reduce the spread of the disease. Detection of rifampicin resistance by phage assay is a useful tool as mycobacteriophages are specific for M. tuberculosis complex and detect viable cells only. In our study, we analyzed 85 samples for rifampicin resistance using a novel mycobacteriophage based test (Phage assay) and radiometric BACTEC 460 TB. Of the 85 samples, 70 (82.35%) were resistant and 12 (14.10%) were sensitive by both methods. Our study yielded a sensitivity and specificity of 100% and 80% respectively. A good correlation was observed with conventional LJ proportion method. We conclude that phage assay allows determination of rifampicin resistance within 48 hours from culture, reducing the time taken to define susceptibility results by BACTEC 460 TB and LJ proportion method (5-7 days and 6-8 weeks respectively).

Treatment satisfaction, functional status, and health-related quality of life of migraine patients treated with almotriptan or sumatriptan

BACKGROUND

Patient-reported outcomes, such as treatment satisfaction, functional status, and health-related quality of life (HRQOL) are essential components of migraine research. Almotriptan is a new selective serotonin 1B/1D agonist triptan migraine treatment.

OBJECTIVE

The purpose of this double-blind, multicenter, randomized, parallel-group study was to compare treatment satisfaction, functional status, and HRQOL of patients treated with oral almotriptan versus sumatriptan, the leading triptan on the market.

METHODS

Migraine patients, aged 18 to 71 years, took equivalent oral doses of 12.5 mg almotriptan or 50 mg sumatriptan for the abortive treatment of a migraine headache. Treatment satisfaction differences between study groups were assessed using a 6-item measure to determine patients' satisfaction with pain relief and satisfaction with side effects 48 hours after drug administration. Functional status was assessed by analyzing the change in patients' ability to perform normal activities during the course of the migraine. HRQOL was compared between treatment groups at 24 hours using the Migraine Quality of Life Questionnaire. End points were assessed using entries from patients' 48-hour diaries.

RESULTS

A total of 1173 patients were treated with almotriptan or sumatriptan. There were no significant differences between the 2 treatment groups in terms of satisfaction with pain relief; however, patients in the almotriptan group were significantly more satisfied (less bothered) with side effects than those receiving sumatriptan (P = 0.016). Functional status and HRQOL outcomes were not significantly different between groups.

CONCLUSIONS

In this study, migraine patients treated with almotriptan were significantly more satisfied with the side-effect profile of the drug than patients treated with sumatriptan. The results of this study may help inform practicing physicians and neurologists about the potential treatment satisfaction advantages of almotriptan.

Patient monitoring using personal area networks of wireless intelligent sensors

A wearable device for monitoring multiple physiological signals (polysomnograph) usually includes multiple wires connecting sensors and the monitoring device. In order to integrate information from intelligent sensors, all devices must be connected to a Personal Area Network (PAN). This system organization is unsuitable for longer and continuous monitoring, particularly during the normal activity. For instance, monitoring of athletes and computer assisted rehabilitation commonly involve unwieldy wires to arms and legs that restrain normal activity. We propose a wireless PAN of intelligent sensors as a system architecture of choice, and present a new design of wireless personal area network with physiological sensors for medical applications. Intelligent wireless sensors perform data acquisition and limited processing. Individual sensors monitor specific physiological signals (such as EEG, ECG, GSR, etc.) and communicate with each other and the personal server. Personal server integrates information from different sensors and communicates with the rest of telemedical system as a standard mobile unit. We present our prototype implementation of Wireless Intelligent SEnsor (WISE) based on a very low power consumption microcontroller and a DSP-based personal server. In future we expect all components of WISE integrated in a single chip for use in a variety of new medical applications and sophisticated human computer interfaces. Existing growth of wireless infrastructure will allow a range of new telemedical applications that will significantly improve the quality of health care.

Hippocampal and hypothalamic type I corticosteroid receptor affinities are reduced in adult rats born by a caesarean procedure with or without an added period of anoxia

Brief periods of hypoxia during labour and birth are a frequent occurrence. Within the CNS, the hippocampus is known to be particularly vulnerable to the damaging effects of hypoxia/ischaemia in both adult and immature animals. The hippocampus also contains the highest concentration of corticosteroid receptors of any brain region and both mineralocorticoid (type I) receptors and glucocorticoid (type II) receptors in the hippocampus play a role in the regulation of basal diurnal and stress-induced glucocorticoid secretion. Given this background, the aim of this study was to test whether an acute period of anoxia during the birth process may have lasting effects on CNS corticosteroid receptor levels and/or pituitary-adrenocortical function. Type I and type II corticosteroid receptor binding sites in the hippocampus and hypothalamus were compared in adult rats that had been born vaginally, born by a Caesarean procedure or born by a Caesarean procedure with 5, 10 or 15 min of added anoxia. Using 14 nM [3H]corticosterone as radioligand, mineralocorticoid receptor binding was reduced by approximately 50% in the hippocampus and hypothalamus of adult rats that had been born by the Caesarean procedure either with or without an added period of anoxia, in comparison to vaginally born controls. Saturation analysis revealed that these reductions resulted from decreases in affinity of the mineralocorticoid receptor for [3H]corticosterone, with no change in numbers of receptors. Birth condition had no effect on glucocorticoid receptor binding capacities in the hippocampus or hypothalamus. A small increase in basal corticosterone secretion during the diurnal trough was observed in adult animals that had been born by Caesarean section with 5 or 15 min of added anoxia. The plasma corticosterone response to a 20-min restraint stress was reduced in adult animals born by Caesarean section with or without an added period of anoxia, in comparison to vaginally born controls. However the adrenocorticotropin response to stress was largely unaffected by birth condition. The results indicate that an acute birth insult is sufficient to produce long-lasting alterations in hippocampal and hypothalamic mineralocorticoid receptor sites, accompanied by changes in basal and stress-induced glucocorticoid secretion.

Effects of a period of asphyxia during birth on spatial learning in the rat

The present study aimed to test whether an acute period of asphyxia during birth in the rat results in long-term alterations in CNS function. Morphologic studies have indicated that the hippocampus is particularly vulnerable to perinatal anoxia. Thus, the present study tested adult rats, which had undergone acute birth asphyxia, for their performance in spatial learning and memory tasks associated with the hippocampus. Rat fetuses on the day of birth were submitted to an acute period of complete asphyxia by submersion of the isolated uterus into a water bath for 5-20 min before delivery of the pups. Control animals were either born vaginally or delivered by rapid cesarean section. At 1.5 mo of age, rats that had undergone 15 min of birth asphyxia showed no deficit in acquisition of spatial learning, measured as latency to find a hidden platform in the Morris water maze. However, at 4 mo of age, separate groups of rats, which had undergone 10, 15, or 20 min of birth asphyxia, showed a deficit in initial acquisition of the spatial learning task compared with vaginally born controls, whereas the 5-min group performed similarly to controls. After overtraining, there was no difference among groups on short-term (1 wk) retention of the spatial navigation task; however, asphytic animals tested at 1.5 mo and retested at 4 mo showed a slight deficit in retention on retest. Animals that had undergone 15 min of birth asphyxia weighed less than did vaginally born animals, but showed no deficit in swimming ability, spontaneous alternation in a T maze, or other sensorimotor indices.(ABSTRACT TRUNCATED AT 250 WORDS)

Interleukin-2 modulates evoked release of [3H]dopamine in rat cultured mesencephalic cells

Mesencephalic cell cultures were used as a model to investigate the effects of interleukin-2 (IL-2) on evoked release of [3H]dopamine ([3H]DA) and gamma-[3H]-aminobutyric acid ([3H]GABA). At low concentrations (10(-13)-10(-12) M), IL-2 potentiated [3H]DA release evoked by the excitatory amino acids N-methyl-D-aspartate (NMDA) and kainate, whereas higher IL-2 concentrations (10(-9)-10(-8) M) had no effect. IL-2 (10(-14)-10(-8) M) modulated K(+)-evoked [3H]DA release in a biphasic manner, with low concentrations (10(-12)-10(-11) M) of IL-2 potentiating and higher concentrations (10(-9)-10(-8) M) inhibiting K(+)-induced [3H]DA release. IL-2 (10(-14)-10(-8) M) by itself failed to alter spontaneous [3H]DA release. The inhibition by IL-2 of K(+)-evoked [3H]DA release was reversible and not due to neurotoxicity, as preexposure to IL-2 (10(-8) M) had no significant effect on the subsequent ability of dopaminergic cells to take up and to release [3H]DA. Under our experimental conditions, IL-2 (10(-8) M) did not alter Ca(2+)-independent [3H]GABA release evoked by either K+ or NMDA. The results of this study indicate that IL-2 is able to potentiate [3H]DA release evoked by a number of different stimuli, including K+ depolarization and activation of both NMDA and non-NMDA receptor subtypes in mesencephalic cell cultures. IL-2 is active at very low concentrations, a finding that indicates a potent effect of IL-2 on dopaminergic neurons and implicates a physiological role for this cytokine in the modulation of DA release.

St-93 hyperglycemia in Wistar rats

The alpha 2-adrenoceptor agonist St-93 was evaluated for its effect on blood glucose levels in Wistar rats. A dose-dependent increase in blood glucose was observed in rats after intraperitoneal administration of St-93. The hyperglycemic effect of St-93 was not altered by prazosin and propranolol, whereas idazoxan significantly inhibited this effect. Pretreatment with reserpine did not affect the hyperglycemic effect of St-93. There was no significant increase in the blood glucose values with St-93 in streptozotocin-diabetic rats. It may be concluded that the hyperglycemia induced by St-93 is mediated through alpha 2-adrenoceptors, possibly located on pancreatic beta-cells.

Effect of bezafibrate & nicotinic acid on triton induced hyperlipidemias in CFY rats

The two mechanisms of action of bezafibrate and nicotinic acid and their combination were evaluated in normal rats and triton treated rats. Bezafibrate was effective hypolipidemic agent in normal rats, but addition of nicotinic acid has certainly improved the effectiveness further which could be of clinical significance. In triton treated rats bezafibrate and nicotinic acid used individually and together had prophylactic hypolipidemic action. However, in their therapeutic effectiveness, bezafibrate reduced triglycerides (65.4%) and nicotinic acid, cholesterol (39.3%). But when treated together they showed marked acceleration in the removal of cholesterol as well as triglycerides. It is therefore concluded that a combination of bezafibrate and nicotinic acid may be beneficial in the treatment of hyperlipoproteinemias, both prophylactically and therapeutically.

Pre-clinical toxicity of IDPH-791: a new centrally acting muscle relaxant in rats

IDPH-791, a novel centrally acting muscle relaxant, in doses up to 500 mg/kg (po) for 14 days did not result in any appreciable adverse effect on body weight gain, food or water consumption including biochemical and haematologica parameters in rats. Variations observed in the biochemistry and haematology were either comparable to controls or were within normal limits.