An X across the Chest: A Rare Case of a Criss-crossed Sternalis Muscle.

OBJECTIVE: The present case study aims at drawing attention to a very rare presentation of the sternalis muscle noticed during routine dissection, and is intended to highlight the clinical significance and usefulness of this unique muscle in reconstructive surgeries, especially of the breast. CASE REPORT: Though many morphological variants of the muscle have been reported, we came across a unique bilateral sternalis muscle during routine dissection for undergraduate medical teaching, in an 80-year-old male cadaver. The muscle originates on both sides from the external oblique aponeurosis from the fleshy belly, and after becom-ing tendinous, converges in the midline to form a common tendon at the level of the sternal angle, and then splits again into two tendons which become continuous with the ipsilateral sternocleidomastoid. CONCLUSION: Notwithstanding the fact that the presence of a sternalis can be misdiagnosed as a wide range of anterior chest wall lesions and tumors, especially with misdiag-nosis of breast masses in routine mammograms, it has great use as a muscular flap for reconstructive surgeries of the anterior chest wall, head, neck and breast.

Biomarkers for Early Detection of Charcot Arthropathy: A Prospective Study on Type 2 Diabetes Patients with Severe Neuropathy.

BACKGROUND: Charcot arthropathy (CA) is a progressive noninfectious inflammatory disease that causes irreversible destruction to pedal architecture in diabetic neuropathy (DN) patients. The debilitating prognosis demands early detection to prevent the development and progression of this disorder. Dysregulated and persistent production of inflammatory cytokines is reported as the key element in initiating osteoclastogenesis in CA. The study analyzed the potential association of markers of inflammation and bone turnover of prediagnostic serum samples on CA. METHODS: Seventy-one type 2 severe DN patients were selected based on inclusion-exclusion criteria. Serum samples of interleukin 6 (IL-6), osteoprotegerin (OPG), bone alkaline phosphatase (BALP), and C-reactive protein (CRP) were analyzed. These patients were followed for the development of symptoms of CA for 12 months. In the year of monitoring, 7 patients developed CA (group 1), whereas the remaining 64 patients did not develop CA (group 2). RESULTS: The rate of development of CA in patients with severe DN was 9.8%. In this group, significantly increased median values of HbA1c (group 2: 8.00 [7.00-9.00], group 1: 10.00 [9.25-11.50], P = .013); IL-6 (group 2: 1.21 [0.72-2.16], group 1: 11.08 [6.65-63.64], P = .008); and CRP (group 2: 1.25 [0.78-3.20], group 1: 3.31 [1.18-41.33], P = .041) were found. The receiver operating characteristic analysis showed that IL-6 was more strongly associated with the onset of CA (IL-6: area under the curve = 0.808; P = .008) than CRP. Cut-off values of ≥6.6 for IL-6 show potential to rule out CA in high-risk patients, with a positive predictive value of 26.1%, a negative predictive value of 97.9%, a sensitivity of 85.7%, and a specificity of 73.4%. CONCLUSION: In our study population, we found that an exacerbated inflammatory state, reflected by IL-6 values, generally occurred in DN patients before the clinical detection of CA. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Small but viscious: the subclavius posticus muscle / Pequeño pero vicioso: el músculo subclavius posticus

SUMMARY: Accessory muscles of the neck are rare and are of clinical significance when present. During routine dissection of head and neck, two accessory muscles were found in the neck region of two cadavers, both male, one on the right and the other on the left. Both muscles took origin from the superior margin of the scapula and the insertion of the first muscle was to the clavicle, merging with subclavius and the second muscle got inserted to the first rib near the costochondral junction. This paper highlights the clinical significance and embryological aspects of such accessory muscles in the neck region.

RESUMEN: Los músculos accesorios del cuello son infrecuentes y tienen importancia clínica cuando están presentes. Durante la disección de rutina de la cabeza y el cuello, se encontraron dos músculos accesorios en la región del cuello de dos cadáveres, ambos de sexo masculino, uno a la derecha y otro a la izquierda. Ambos músculos se originaban en el margen superior de la escápula y la inserción del primer músculo se extendía a la clavícula, fusionándose con el músculo subclavio. El segundo músculo se insertó en la primera costilla cerca de la unión costocondral. Este artículo destaca la importancia clínica y los aspectos embriológicos de dichos músculos accesorios en la región del cuello.

Variations in the inter-lobar fissures of lungs obtained from cadavers of south Indian origin / Variaciones en las fisuras pulmonares interlobulares de cadáveres del sur de la India

The proposed aim of the study was to elucidate the variations of the lung fissures and to correlate their importance in clinics. The study was conducted on 48 lung specimens, 30 right and 18 left, obtained from the cadavers of South Indian origin. Among the right-sided lungs, 2 specimens showed absence of horizontal fissure, and the remaining 25 showed incomplete horizontal fissure. Oblique fissure was incomplete in 15 lungs and one lung showed absence of oblique fissure. An accessory fissure was observed in 4 lungs. Among the left sided lungs, the oblique fissure was incomplete in 7 lungs. The presence of an accessory fissure was found in 5 lungs. With the development of radiological and endoscopic techniques and the advancement of pulmonary surgery, the knowledge of morphological variations of lung fissures is of utmost importance to clinicians to correctly locate the bronchopulmonary segment during pulmonary lobectomy, and for radiologists to correctly interpret X-rays and CT scans.

El objetivo fue determinar las variaciones de las fisuras del pulmón y correlacionarlas con su importancia clínica. Se utilizaron 48 muestras de pulmón, 30 del lado derecho y 18 del izquierdo, obtenidos de cadáveres de origen del Sur de la India. Entre los pulmones, en el lado derecho, dos mostraron ausencia de la fisura horizontal, y 25 mostraron una fisura horizontal incompleta. La fisura oblicua fue incompleta en 15 pulmones y en 1 pulmón estuvo ausente. Se observó una fisura accesoria en 4 pulmones. Entre los pulmones del lado izquierdo, la fisura oblicua estuvo incompleta en 7 casos. La presencia de una fisura accesoria se observó en 5 casos. Con el desarrollo de técnicas radiológicas, endoscópicas y el avance de la cirugía pulmonar, el conocimiento de las variaciones morfológicas de las fisuras de pulmón es de importancia para los médicos, permitiendo localizar correctamente el segmento broncopulmonar durante la lobectomía, y para los radiólogos para interpretar correctamente las radiografías y las Tomografías Computarizadas.

Bilateral presence of axillary arch muscle passing through the posterior cord of the brachial plexus / Presencia bilateral del arco muscular axilar pasando por el fascículo posterior del plexo braquial

The axillary arch can be described as an anomalous muscular slip of latissimus dorsi muscle. In this paper, a rare case of bilateral axillary arch is reported during routine dissection of the axillary region of a 57-year old male cadaver. On both sides, the axillary arch muscle took origin from latissimus dorsi and teres major, and passed upwards through the posterior cord of the brachial plexus, but posterior to the bulk of axillary neurovascular bundle. It then split into two slips: the medial slip was inserted into the root of the coracoid process, while the lateral slip which was intracapsular, was attached to the lesser tubercle, above the attachment of subscapularis. The presence of the muscle has important clinical implications, and the position, bilateral presence, penetration of the posterior cord, and multiple connective tissue attachments makes the case most unique. The anatomy, surgical implications, and embryology of the anomalous muscle are discussed in this paper.

El arco axilar puede ser descrito como un fascículo muscular anómalo del músculo latísimo del dorso. En este trabajo, un raro caso de arco axilar bilateral se encontró durante la disección de rutina de la región axilar de un cadáver de 57 años de sexo masculino. En ambos lados, el músculo arco axilar se originó desde los músculos latísimo del dorso y redondo mayor y pasó hacia arriba a través del fascículo posterior del plexo braquial, pero posterior a la mayor parte del paquete neurovascular axilar. A continuación, se dividió en fascículos: el fascículo medial se insertó en la raíz del proceso coracoides, mientras que el fascículo lateral, era intracapsular y se insertaba en el tubérculo menor del húmero, por encima de la inserción del músculo subescapular. La presencia de este músculo axilar tiene importantes implicaciones clínicas, y la posición, la presencia bilateral, la penetración del fascículo posterior, y múltiples uniones de tejido conectivo hacen al caso más especial. La anatomía, las implicaciones quirúrgicas y embriología del músculo anómalo son discutidos en este trabajo.