Re-visiting the brachialis muscle: morphology, morphometry, gender diversity, and innervation.

PURPOSE: The brachialis (BM) is a complex muscle with a long-running controversy regarding its morphology and innervation. The primary objective of this study was to elucidate the detailed gross morphology of BM in an adult Sri Lankan population. METHOD: Cadaveric upper limbs (n = 240) were examined for the proximal and distal attachments, length, width, thickness of BM, and innervations by the musculocutaneous (MCN) and radial nerve (RN). RESULTS: In all cases, the BM consisted of two heads: superficial head (SHB) and deep head (DHB). Proximally SHB and DHB originated from the lateral, anterior, and medial aspects of the middle and distal thirds of the shaft of the humerus and inserted onto the coronoid process and the tuberosity of ulna, respectively, as two separate entities. Statistically significant (P < 0.05) gender differences were observed between the mean values (mm) of muscle length (male: 188.03 ± 10.54; female: 166.14 ± 7.97), width (male: 26.57 ± 4.80; female: 25.28 ± 4.67), thickness (male: 10.73 ± 1.74; female: 9.74 ± 1.28), and tendon length (male: 44.44 ± 7.73; female: 33.40 ± 5.09). In all cases, MCN innervated the BM, while the model site of piercing was in the middle third of the muscle. The incidence of RN contribution to BM was 83.33% and in the vast majority it pierced the inferior third of the BM. CONCLUSION: Present study provides a comprehensive anatomical overview of the BM. An in-depth knowledge of the anatomy of BM may aid in comprehending functional characteristics, enhance the accuracy of imaging modalities, and provide new insight to the current surgical approaches around the elbow joint which in turn will invariably minimize the potential complications encountered during clinical procedures.

Comparison of spatula and cytobrush cytological techniques in early detection of oral malignant and premalignant lesions: a prospective and blinded study.

BACKGROUND: The use of oral cytology to diagnose malignant and premalignant lesions at an early stage is considered crucial. The aim of this study was to evaluate the diagnoses of the spatula and the cytobrush techniques compared with the gold standard histopathological findings, analysed according to different diagnostic criteria. METHODS: Cytological smears were obtained from 76 suspicious oral malignant lesions and 116 oral leukoplakia lesions using two techniques: cytobrush plus cell collector and metal spatula. Subsequently, a surgical biopsy was performed on each lesion to achieve a histopathological diagnosis. Evaluation was conducted with respect to three different diagnostic criteria. RESULTS: The sensitivity for diagnosing carcinoma in clinically malignant cases was 89.58% and 60.42% for cytobrush and spatula techniques, respectively. Inclusion of severe dysplastic cases for 'high-risk' lesions increased the sensitivity up to 96.36% and 78.18% for two techniques, respectively. In leukoplakia lesions, malignant and severely dysplastic cells were diagnosed at a sensitivity of 88.89% in the cytobrush and 55.56% in the spatula techniques. Extending the criteria by defining malignant or any dysplastic findings as positive, sensitivity was increased to 98.02% and 89.11% for the spatula and the cytobrush techniques, respectively. Specificity for both techniques increased to 100%. The difference between the diagnoses of histopathology and the spatula cytology was statistically significant (P < 0.01), while no such difference was found with the cytobrush technique (P > 0.1). CONCLUSION: The cytobrush, unlike the spatula, is a useful screening instrument for early diagnosis of suspicious oral lesions and could therefore contribute to improved oral cancer prognosis.

Coracobrachialis muscle: morphology, morphometry and gender differences.

PURPOSE: Coracobrachialis (CBM) is a complex muscle with a wide range of variations in its morphology and innervation. The goal of this study was to elucidate the morphology, morphometry, gender differences of CBM and precise anatomical position of the musculocutaneous nerve (MCN) with reference to surrounding anatomical landmarks in an adult Sri Lankan population. METHOD: Cadaveric upper limbs (n = 312) were examined for the proximal and distal attachments, length, width, thickness of CBM and its relationship with the MCN. RESULTS: The CBM originated from the tip of the coracoid process of the scapula and lateral, posterior and medial aspects of the tendon of short head of biceps brachii. Gender differences were observed in all morphometrical parameters of CBM. In 83.33 %, MCN perforated the CBM. In 50 % the MCN pierced the middle one-third of CBM while none pierced the lower one-third. The distance from the coracoid process to the point of entry of MCN into CBM (distance P) was 50.62 mm. A positive correlation was observed between the arm length and distance P indicating that arm length provides an accurate and reliable means of gauging the distance P of an individual. CONCLUSION: The present study provides new evidence pertaining to the origin of CBM. Further, it was revealed that the predicted distance P of any upper extremity can be calculated by dividing the arm length by 5. Precise anatomical location of MCN in relation to CBM using unequivocal and well-defined anatomical landmarks will be imperative in modern surgical procedures.

Xylem parenchyma cell walls lack a gravitropic response in conifer compression wood.

MAIN CONCLUSION: Cell wall fluorescence and immunocytochemistry demonstrate that xylem parenchyma cell walls do not show changes in structure and composition related to gravitropic response comparable to those of tracheids, even when they have lignified secondary cell walls. Tracheid cell walls in compression wood have altered composition and structure which generates the strain responsible for correction of stem lean as part of the gravitropic response of woody plants. Xylem parenchyma cell walls vary among conifer species and can be lignified secondary walls (spruce) or unlignified primary walls (pine). It can be expected that xylem parenchyma with lignified secondary cell walls might show features of compression wood comparable to those of tracheids that have a similar type of cell wall. A comparison of xylem parenchyma cell walls in normal and compression wood in species with lignified and non-lignified parenchyma cell walls provides a unique opportunity to understand the process of reaction wood formation in conifers. Using both UV/visible fluorescence microscopy of cell wall fluorophores and immunocytochemistry of galactan and mannan epitopes, we demonstrate that xylem parenchyma cell walls do not show the changes in composition and structure typical of compression wood tracheids. Adjacent cells of different types but with similar cell wall structure can undergo cell wall developmental changes related to support or defence functions independent of their neighbours. Tracheids are sensitive to gravitropic signals while xylem parenchyma cells are not.

Maintenance of oxygenation during total intravenous anaesthesia with ketamine while breathing air.

OBJECTIVE: To determine the variation in arterial oxygen saturation during intravenous ketamine anaesthesia while breathing air. DESIGN: Prospective study. SETTING: General Hospital, Anuradhapura. PATIENTS AND METHOD: 65 patients of both sexes between the ages 10 to 60 years scheduled for minor surgery lasting five to 15 minutes were selected. Anaesthesia was induced with intravenous diazepam and ketamine and patients were allowed to breathe air. MEASUREMENTS: Arterial oxygen saturation, respiratory rate, degree of analgesia both during and one hour after surgery, incidence of nausea, vomiting and hallucinations after recovery were recorded. RESULTS: Five patients (7.6%) showed a fall in oxygen saturation to less than 90%. Three of them had airway obstruction and the other two were obese. Nausea and vomiting occurred in eight patients (12%). Hallucinations were noted in five patients (7%). Postoperative analgesia was present one hour after surgery in 54 patients (83%). CONCLUSION: Young and otherwise healthy patients maintained normal oxygen saturation while breathing air provided airway patency is maintained. However, facilities for administration of oxygen, intubation and ventilation should be available during ketamine anaesthesia.

Occipito-frontal circumference as a personal stature predictor in a group of Sri Lankan adults / Circunferencia occipito-frontal como predicción de la estatura en un grupo de adultos de Sri Lanka

SUMMARY: Accurate estimation of the personal stature is important in calculating body mass index, assessing nutritional status and the risk of cardiovascular disease, prediction of energy needs and in adaptation of cytostatic drug doses. However, various situations such as, patients in emergency or critical care settings or immobilized patients who are bed ridden or in wheelchairs make it difficult or even impossible to obtain the personal stature using standardized methods. Thus, the need for an alternate method of personal stature prediction arises. Despite its potential practical utility, little is known concerning the relationship between occipito-frontal circumference (OFC) of the head and personal stature among the adult Sri Lankans. Therefore, the goal of this study was to propose population and sex specific regression formula for personal stature estimation using the OFC. Personal stature and OFC was recorded in a total of 156 cadavers belonging to 55 - 89 years of age: (male: n=74; female: n=82). Subjects with any craniofacial deformities or history of neurological disorders were excluded from the study. The mean stature (cm) (male:162.08 ± 9.02 ; female:157.04 ± 9.59) and OFC (cm) (male: 54.09 ± 3.28 ; female: 52.88 ± 2.83) of the study subjects were found to be significantly different (P< 0.01) between the sexes. Correlation coefficient between the OFC and personal stature was statistically significant and positive in both males (0.62) and females (0.86) indicating a strong relationship between the two parameters. Linear regression formulae for the prediction of personal stature using the OFC were derived as follows: male: 70.52 + 1.69 (OFC); female: 3.48 + 2.92 (OFC). Stature prediction equations that require a measuring tape as the only tool to record the OFC provides a practical alternative for the height estimation of patients who are unable to stand due to various reasons. It is a simple, cost effective, non invasive and objective method for personal stature prediction. Accurate prediction of a patient's stature will in turn, reduce potential errors that may occur when stature is estimated only by visual observation in emergency or clinical situations. Complementary studies are necessary to evaluate the applicability of these equations in other age groups too.

RESUMEN: La estimación precisa de la estatura es importante para calcular el índice de masa corporal, evaluar el estado nutricional, como también el riesgo de enfermedad cardiovascular, las necesidades energéticas y la adaptación de las dosis de los fármacos citostáticos. Sin embargo, varias situaciones, por ejemplo en situaciones de emergencias médicas o cuidados intensivos, los pacientes inmovilizados en cama o en silla de ruedas, se hace difícil o incluso imposible obtener la estatura usando métodos estandarizados. Por lo tanto, surge la necesidad de un método alternativo de predicción personal de la estatura. A pesar de su potencial utilidad práctica, se sabe poco sobre la relación entre la circunferencia occipito-frontal (COF) de la cabeza y la estatura entre los adultos de Sri Lanka. El objetivo de este estudio fue proponer una fórmula específica para la estimación de la estatura de acuerdo a población y sexo utilizando la COF. La estatura individual y la COF se registraron en un total de 156 cadáveres pertenecientes a individuos de 55-89 años de edad (hombre: n = 74, mujer: n = 82). Los sujetos con deformidades craneofaciales o antecedentes de trastornos neurológicos fueron excluidos del estudio. Se encontró que la estatura media (cm) (varón: 162,08 ± 9,02, mujer: 157,04 ± 9,59) y OFC (cm) (hombre: 54,09 ± 3,28, mujer: 52,88 ± 2,83) era significativamente diferente (P < 0,01) entre los sexos. El coeficiente de correlación entre la COF y la estatura fue estadísticamente significativo y positivo tanto en varones (0,62) como en mujeres (0,86), lo que indica una fuerte relación entre los dos parámetros. Las fórmulas de regresión lineal para la predicción de la estatura utilizando la COF se obtuvieron de la siguiente manera: hombres: 70,52 + 1,69 (COF); mujeres: 3,48 + 2,92 (OFC). Las ecuaciones de predicción de la estatura que requieren una cinta métrica como la única herramienta para registrar la COF proporcionan una alternativa práctica para estimar la altura en aquellos pacientes que no pueden ponerse de pie por diversos motivos. Es un método sencillo, rentable, no invasivo y objetivo para la predicción personal de la estatura. La predicción exacta de la estatura del paciente, a su vez, reducirá los errores potenciales que pueden ocurrir cuando la estatura se estima sólo por observación visual en situaciones de emergencias o clínicas. Estudios complementarios son necesarios para evaluar la aplicabilidad de estas ecuaciones en otros grupos de edad.

Evaluation of 22q11.2 deletion in Cleft Palate patients.

BACKGROUND: Cleft palate is the commonest multifactorial epigenetic disorder with a prevalence of 0.43-2.45 per 1000. The objectives of this study were to evaluate the clinical features and identify the 22q11.2 deletion in patients with cleft palate in Sri Lanka. MATERIALS AND METHODS: Cleft patients attending a Teaching Hospital in Sri Lanka were recruited for this study. The relevant data were obtained from review of case notes, interviews, and examination of patients according to a standard evaluation sheet. Quantitative multiplex polymerase chain reaction (PCR) was performed to identify the 22q11.2 deletion. A gel documentation system (Bio-Doc) was used to quantify the PCR product following electrophoresis on 0.8% agarose gel. RESULTS AND CONCLUSION: There were 162 cleft palate patients of whom 59% were females. A total of 92 cleft palate subjects (56.2%) had other associated clinical features. Dysmorphic features (25.27%) and developmental delays (25.27%) were the commonest medical problems encountered. The cleft was limited to the soft palate in 125 patients, while in 25 patients it involved both the hard and the soft palate. There were seven subjects with bifid uvula and five subjects with submucous cleft palate. None of the patients had 22q11.2 deletion in this study population. A multicentered large population-based study is needed to confirm the results of this study and to develop guidelines on the appropriate use of 22q11.2 deletion testing, which are valid for cleft palate patients in Sri Lanka.

Sexual differences in the diameter of coronary arteries in an adult Sri Lankan population / Diferencias sexuales en el diámetro de las arterias coronarias en una población adulta de Sri Lanka

Coronary artery disease is a major cause of human mortality. It is stated that females have worse outcomes than men following myocardial infarction and coronary revascularization. Sexual differences in the coronary artery diameters have also been speculated as one of the reasons for the above outcome. However, because of possible confounding effects, such as the body size and heart weight, it is unclear if there is a true sex-specific effect on coronary arterial size. The present study was undertaken to investigate the sexual differences in the diameter of coronary arteries in a group of adult Sri Lankan population. The diameters of the coronary arteries and their branches were measured at predetermined sites in a total of one hundred and two apparently healthy hearts obtained from cadavers during routine gross anatomy dissections. All measurements were taken using a digital sliding caliper capable of measuring to the nearest 0.01mm. The mean coronary arterial diameters were significantly smaller in females than in males. These differences persisted even after the diameters of coronary arteries were corrected for heart weight and body surface areas. Precise knowledge of the expected normal coronary arterial diameter at a given anatomic location is the first step towards developing a quantitative estimate of the severity of the coronary artery disease. This study provides a reference data set for adult Sri Lankans against which to compare the diameters of coronary arteries in various pathological conditions.

La enfermedad coronaria es la mayor causa de mortalidad humana. Se afirma que las mujeres tienen peores resultados que los hombres después de un infarto de miocardio y revascularización coronaria. Diferencias sexuales en los diámetros de las arterias coronarias han sido especuladas como una de las razones para los resultados anteriores. Sin embargo, debido a posibles efectos de confusión, tales como talla corporal y peso del corazón, no está claro si hay un verdadero efecto sexo-específico sobre el tamaño arterial coronario. El presente estudio se realizó para investigar las diferencias sexuales en el diámetro de las arterias coronarias en un grupo de adultos de la población de Sri Lanka. Los diámetros de las arterias coronarias y sus ramas se midieron en lugares predeterminados en un total de 102 corazones aparentemente sanos obtenidos de cadáveres durante las disecciones anatómicas de rutina. Todas las medidas fueron tomadas con un caliper digital deslizante (precisión 0,01 mm). La media del diámetro arterial coronario fue significativamente menor en mujeres que en hombres. Estas diferencias persisten aún después de que los diámetros de las arterias coronarias fueron corregidos por el peso del corazón y talla corporal. El conocimiento preciso del diámetro de la arteria coronaria normal esperado en un determinado lugar anatómico es el primer paso hacia el desarrollo de una estimación cuantitativa de la gravedad de la enfermedad de las arterias coronarias. Este estudio proporciona un conjunto de datos de referencia para adultos de Sri Lanka con el cual comparar los diámetros de las arterias coronarias en diversas condiciones patológicas.

Reproducibility of an oral cancer and precancer detection program using a primary health care model in Sri Lanka.

A pilot feasibility study utilizing primary health care workers (PHCW) in the early detection of oral cancer and precancer was reported in 1984. The present study was to assess the reproducibility of this model in a different geographic area using existing Government Health Services. In order to improve the compliance of individual referrals following detection (54% in the previous study) a simultaneous health education program was mounted. Of 72,867 villagers aged 20 years and over who were allocated for screening, 57,124 (78%) were examined during 1 year by 36 PHCWs. Oral lesions were detected in 3559 (6.2%). Of these, 2193 (62%) complied by presenting for a reexamination at the hospital. Twenty new cancers and 1716 subjects with oral precancerous lesions were confirmed. While the population screening coverage achieved was higher than in the feasibility study, compliance was marginally improved. Noteworthy, however, was the detection of 20 new cancers as compared to 4 in the feasibility study. This primary health care model for cancer detection appears to be organizationally feasible for a developing country.