An Erratic Origin of Quadratus Plantae: An Embryological Error

Background: Quadratus plantae (Flexor digitorum accessorius) is one of the plantar muscles of foot . It is present in the second layer of sole. It takes origin from calcaneus and gets inserted into the tendon of flexor digitorum longus. The main function of it is to flex the lateral four toes in any position of the ankle joint by pulling on tendons of the flexor digitorum longus. Its variations like high origin have been implicated in the causation of tarsal tunnel syndrome. Methodology and Results: In routine dissection done on 22 cadavers, we observed a bilateral variant muscle flexor digitorum accessorius longus on both right and left sides in a male cadaver. The modality of choice in diagnosing the accessory muscle is magnetic resonance imaging. Conclusion: The knowledge of this variation would be essential to anatomists, radiologists and also to the foot surgeons while performing posterior ankle endoscopy. KEY WORDS: Flexor digitorum Accessorius longus, Tarsal tunnel syndrome, Posterior ankle endoscopy.

A RANDOMIZED COMPARATIVE CLINICAL EVALUATION OF HARIDRADI LEHA AND VASADI KASHAYA IN THE MANAGEMENT OF TAMAKA SHWASA (BRONCHIAL ASTHMA)

Tamaka Shwasa in Ayurveda is analogous to Bronchial Asthma due to similarity in causative and precipitating factors, onset, pathogenesis and symptoms. An estimated 300 million people worldwide suffer from asthma, with 250,000 annual deaths attributed to the disease. The Objective is to evaluate and compare the efficacy of Haridradi Leha with and without Vasadi Kashaya in the management of Tamaka Shwasa. Total 30 patients were registered for the present study. The patients of group A were administered Haridradi Leha in a dose of 20 grams BD (Bis in die i.e., twice daily) in empty stomach orally with lukewarm water for 21 days. The patients of group B were administered Haridradi Leha (20 grams BD) and Vasadi Kashaya (50 ml BD) with Anupana (co-administers with medicine) of honey orally for 21 days. There are highly significant results (p value: p<0.01, p<0.001) in breathlessness, cough, body position, wheezing in a day, wheezing in night, heart rate in both group but quantity of sputum, respiratory rate, use of accessory muscle and mental status shows highly significant result only in Group B. Both groups have highly significant result in peak expiratory flow rate (PEFR) and forced expiratory volume in one second (FEV1). Both the Haridradi Leha and Vasadi Kashaya are highly effective in the management of Tamaka Shwasa. Haridradi Leha along with Vasadi Kashaya provided better relief than Haridradi Leha alone in most of the sign and symptom of the disease at significant level.

Morphology of Piriformis- its clinical implications in Piriformis syndrome

Background and Aim: Anatomical variations of neuromuscular structures of gluteal region are common. Each and every anatomical variation reflects a different and case specific clinical presentation. Piriformis is the key muscle to this region. This work was done to re-investigate the morphology of this muscle and structures related to it, in sufficient number of specimens to correlate with clinical syndrome. Materials and Methods: 60-lower extremities with gluteal region belonging to 30 embalmed adult human cadavers named as specimens comprised the material for this study. Gluteal region was dissected to see the variations in the origin, insertion and accessory slips of piriformis muscle. Results and Conclusion: Out of 60 specimens, piriformis consisted of one belly in 55 specimens (91.67%) and two bellies were observed in 5 specimens (8.33%). In two specimens belonging to one male cadaver, the piriformis was found being pierced by common trunk for inferior gluteal and common peroneal nerves whereas in three specimens piriformis was also being pierced by one root of posterior cutaneous nerve of thigh An accessory muscle was observed bilaterally in one cadaver. This accessory muscle was present below the piriformis on right side& it was related with the emergence of tibial nerve in between the piriformis and accessory muscle which is a rare pattern. On left side this accessory muscle was present above the piriformis & was associated with presence of superficial branch of superior gluteal artery between the upper border of piriformis and this accessory muscle. All these variations should be kept in mind during physical examination or evaluating radiological images of patients with low back pain. KEY WORDS: Anatomical variation, Piriformis, Pirifomis syndrome, extraspinal sciatic.

A COMPARATIVE STUDY OF METERED DOSE INHALER WITH SPACER AND DRY POWDER INHALER FOR DELIVERY OF SALBUTAMOL IN ACUTE EXACERBATIONS OF BRONCHIAL ASTHMA

Objective: To compare the efficacy of metered dose inhaler with spacer with dry powder inhaler for delivery of salbutamol in acute exacerbation of bronchial asthma Design:Randomized controlled trial in the Setting of Department of Pediatrics, Patna Medical College and Hospital Patna Methods: Children in the age group of 5 - 12 years who presented with a mild or moderate acute exacerbation of asthma were randomized to receive 400 mcg salbutamol by either a MDI with spacer or a DPI. The changes in the wheezing and accessory muscle scores, SaO2, and PEFR were recorded and subjected to statistical tests for significance. Results: Two hundred and fifty-three children were studied; 128 were assigned to the MDI-spacer group and 125 to rotahaler (DPI) group. After receiving treatment, the PEFR improved by about 11% in both the groups. The oxygen saturation increased by 2% in both the groups.Within each group, the improvement in PETR, SaO2, wheeze and accessory muscle score after the treatment was statistically significant. Conclusion: Metered dose inhaler with spacer and dry powder inhaler are equally effective in delivering salbutamol in therapy of mild to moderate acute exacerbations of bronchial asthma in children between 5-12 years of age.

A Possible Accessory Muscle of the Serratus Posterior Superior Muscle

Anatomical variation is defined as the normal range of possibilities in the topography and morphology of body structures. In contrast, an anomaly is any structural or functional anatomical finding beyond the normal range of possibilities. This case study describes a muscular anomaly found in a 73-year-old preserved Caucasian male. We observed a left-sided anomalous muscle originating from the transverse process of the C1 (Atlas) vertebra and inserting onto the proximal attachment of the serratus posterior superior (SPS) muscle at the C7 level. We suggest that this anomaly is a result of early embryological development and hypothesize that the atypical neck muscle may reinforce the action of the SPS. This finding is rare and no reference of it can be found in the literature. Reporting anatomical anomalies is important for the medical literature and education.

Abstract 16994: Left Ventricle Accessory Antero-Septal Papillary Muscle Detected in the LVOT Vicinity by Means of Cardiac MRI and Echocardiography in HOCM and Control Patients

Background: We studied by means of echocardiography (echo) and cardiac MRI the occurrence of an accessory papillary muscle that unites mostly the left ventricle (LV) apex with the basal or mid antero-septum. Methods: We included all good quality studies as reviewed by two cardiologists and assessed the occurrence of a contractile papillary muscle situated between the LV apex and antero-septum. Results: A contractile accessory papillary muscle situated between the LV apex and the antero-septum was seen in 100% of HOCM patients and 62% of control patients (p=0.05, panels 1-6 HOCM patients and 7-9 controls; panels 1, 4 and 7 - diastole; 2,5 and 8 - early-systole; 3, 6 and 9 - end-systole) in the cardiac MRI images acquired from a total of 22 HOCM (9) and control (13) patients. The same structure was observed in 241 patients representing 69.5% of all-comers echo studies. The age was 69 ± 17 years on average in the echo arm, patients harboring the antero-septal accessory muscle being older (71.6 + 15.7 years old vs 63.5 ± 18.1 for those without, p=0.0005). We exemplify this structure by parasternal long axis still echo images from 24 patients (panel 14) as well as more detailed images from 4 patients in the same group (panels 10-13). Red arrows point out the accessory antero-septal papillary muscle and white arrows the antero-septum. Pink and yellow dots neighbor the regular antero-lateral and postero-medial pap muscles and the white dots the mitral valve. Conclusion: A contractile accessory papillary muscle was observed in slightly more than half of the all-comer echo studies, and in all HOCM patients in the cardiac MRI arm. Further research is needed to fully characterize the anatomical and physiological significance of this structure attaching in the immediate vicinity of the LVOT in HOCM and control patients.

About the perverted light reaction of the pupils

In view of the special interest of our case, we will enter here into consideration of the anatomical and physiological side of the normal light reaction and try to explain the peculiar symptom observed in the patient, which is called the perverted or paradoxical reaction of the pupils. As is known, the common oculomotor nerve innervates the muscle that lifts the upper eyelid, the four external ocular muscles: the internal, upper and lower rectus, lower oblique and two internal muscles of the eye the orbicular muscle of the pupil and the lumbar muscle, there are probably only seven muscles. The physiological conditions of the movement of the eye muscles convince us that not all of them have a separate movement. Excluding the lower oblique, which plays the role of an accessory muscle, and the orbicular muscle of the pupil, which is not rapidly contracting together with the lumbar muscle, all other muscles are so adapted to isolated movements that, it would seem, one could expect the corresponding differentiation in their nuclei.