Jnana srotas febraury


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Jnana srotas febraury

  1. 1. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4Apl-Sept. -2011/ Oct - March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue - 1-2 / 3-4
  2. 2. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 All India sharira research institute,(AISRI) Karnataka regional branch EXECUTIVE BODYmembers PATRON : Veerendra Heggade Poojya Dr. D. Dharmadhikari Shri Kshetra Dharmasthala DIRECTOR : Dr. Prasanna N Rao, Prof.& Principal S D M College of Ayurveda, Hassan. CHAIRMAN : Dr. Giridhar M Kanthi, Prof & Head, Dept. of Basic Principles S D M College of Ayurveda, Kuthpady – Udupi VICE CHAIRMAN : Dr.N.Muralidhara, Prof. Dept of Shareera Rachana Sri Sri Ayurveda Medical College Udayapur Bangalore Dr. U. Govindaraju Prof & Head, Dept. of Shareera Rachana S D M College of Ayurveda Kuthpady – Udupi Dr. S B Kottur, Prof Alva’s Ayurveda Medical College, Moodabidri. SECRETARY : Dr. B.G. Kulkarni, Asst. Prof. SDM College of Ayurveda, Hassan JOINT SECRETARIES: Dr. Vinod kumar Alapati Asst. Prof. Dept of Shareera Rachana Rajeev Ganndhi Ayurvedic Medical College MAHE. Kerala Dr.R.V.Pakkannavar, Prof & Head Dept of Shareera Rachana KLE’s B M K Ayurvedic Medical College,Belgaum. HONORARY SECRATARIES: Dr. B G Swami Prof & Head Shareera Rachana D G M Ayurvedic Medical College, Gadag Dr. S B Govindappaavar, Prof. Dept of Shareera Rachana D G M Ayurvedic Medical College, Gadag Dr. B B Hunagund Prof & Head Shareera Rachana Ayurveda Mahavidyalaya Hubli. Dr Uma Prof. Dept. of Shareera Rachana S D M College of Ayurveda Kuthpady – Udupi TREASURER : Dr. Hemanth D Toshikhane Prof. Dept of Shalya KLE’s B M K Ayurvedic Medical College, Belgaum.
  3. 3. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 EDITORIAL BOARD EditorialManaging Editor Dear colleagues,Dr G. M. Kanthi, Prof. SDMCA,Udupi Seasonal Greetings to all Faculty Members, The Jnana Srotas new issue gives new information about the anatomical variationsChief Editors articles which will be found during the routineDr. Prasanna N. Rao, Principal, SDMCA, dissection at Udupi, Manipal and Moodabidari,Hassan Ayurveda colleges during their U G & P.G.Dr. U.N. Prasad, Principal, SDMCA, Udupi. dissection Classes. The upper limb muscular variations mainly biceps brachi and palamaris longus, superficial veins including varicoseCo - Editors vein articles are really very informative topics.Dr. K.R.Ramchandra, Prof. SDMCA Udupi Such anatomical variations knowledge is mostDr. N Muralidhar, Prof. Sri Sri AMC B,lore important in the field of surgical and medicinalDr. Jayakrishna Nayak, Lect. SDMCA, Udupi point of view.Dr. S.B. Govindappanavar, Prof. DGM AMC, The Dept of anatomy Kasturba MedicalGadag College Manipal, was organized the one day C.M.E on Advance imaging technique on the anatomy understanding through radio-imagingAdvisory Board technique, the benefit of this knowledgeDr. Sridhar Holla Prof. SDMCA Udupi was attempted by Post Graduate ScholarsDr. Suresh Negalguli, Prof PNMAMC, Kerala of Sri Dharmasthal Manjunatheswar College of Ayurveda Udupi, and Under GraduateDr. B. G. Swami, Prof. DGMAMC Gadag students of Muniyal Ayurveda college Manipal and other P.G Scholars of different medicalMembers college students. Such advanced teaching methodology was very impressive to mostDr. U. Govind Raju, Prof. SDMCA Udupi of the young anatomist; there was anatomyDr. R.V. Pakkannavar, Prof. BMKAMV quiz to the P.G. Scholars in one session it isBelgaum also very effective to the all participants. SuchDr. B B Hunagund, Prof. AMV Hubli reorientation teaching programs are essentialDr. Vinoda Alpathi, Asst.Prof RGAMC, in the field of medical teaching profession. TheMahe Kerala same may be adopted in Ayurvedic colleges.Dr. R.N.Gennur prof. Dr.BNMRAMC Bijapur This year National Conference of Shareera Rachana (Anatomy) held at koppal on 15thDr. Uma G. Gubbi, Prof BAMC Davangere October 2011 organized by shree Jagdguru Gavishiddeswar Ayurvedic Medical CollegePublished by Koppal, in association with All India ShareeraAll India Shareera Research Institute Reaserch Institute karnataka S D M College of Ayurveda Hassan Karnataka Regional Branch,KARNARAKA regional BRANCH with blessings of Poojya Shree Ma. Ni. Pra.SDM College of Ayurveda & Hospital, Swa. Jagadguru Abhinava GavisiddheshwarHassan - 573 201 1
  4. 4. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 Mahaswamiji Shree Gavimath Koppal, Contents The AISRI regional branch Hassan, wish to teachers for awarding the best teachers award Page No. 2011. Dr S A Patil retired Prof of anatomy, Ayurveda Mahavidyalaya Bijapur. Dr K B UNILATERAL ACCESSORY HEAD OF THE BICEPS BRACHI – A CASE STUDY 3 Hiremath Prof Vice Principal S J G Ayurvedic Medical College koppal were honored as Primary Varicose Vein of Upper Limb – A Case Report 6 “Best Shareera Teacher Award 2011”. Dr Mahantesha Ramannavar Asst Prof KLE’s BMK A B S E N C E O F PA L M A R I S L O N G U S MUSCLE - A Case Report 7 Ayurveda Mahavidyalaya honored as “Best Young Anatomy Teacher Award 2011”. In 17th “NATIONAL CONFERENCE” -Report 8 century sir William Harvey dissected her sister’s SUPERFICIAL VENOUS VARIATION OF THE body to find out the circulation of blood, Dr UPPER LIMB – A CASE REPORT 9 Mahantesh Ramannavar Ayurvedic anatomist It is no fault of the student because contributed in the field of anatomy from India on a year has only 365 days. 13 13-11-2010, by dissecting his own father’s body Regimen during Winter Season 14 as committed teacher, and also motivating the public’s for Eye and Body donations. Variation in F le x or digitoru m superficialis (sublimis) – A case study 17 Dr B S Ramannavar Memorable GOLD After 25 Years In Woman’s Stomach, MEDAL bagged this year by top scorer in A Pen Still Writes 21 Rachana and Kriya subjects from RGUHS emerylogical Development of Bangalore, Kumara Nandeesha N 333 Marks Testis 22 highest in Shareer Rachana in the year 2009/10 Embryological development of Sri Raghavendra Ayurvedic Medical College, bladder, urethra, uterus and uter- Malladihally Dist – Chitradurga; and Kumari ine tubes, prostate and external genitalia 23 Sushobhitha M 342 Marks highest in Shareer Rachana in the year 2010/11 Shri Dharmasthala STUDY OF PADA PRAMAN WITH SPECIAL REFERENCE TO PLANTAR ARCH INDEX IN Manjunatheshwara College of Ayurveda, Hassan 25 VOLUNTEERS OF VARIOUS REGIONS are honored by Dr Sushiladevi Ramannavar KNOW ABOUT BONES 27 president Dr B S Ramannavar Charitable Trust Bailhongal. ‘SKIN DONATION – A RAY OF HOPE FOR BURN PATIENTS’ 28 AISRI regional branch Hassan, will congratulates to Dr. Muralidhar N for awarding “Shareera Ratna - 2011” by International Association of Physicians. ***** vÉUÏUqÉÉ±Ç ZÉsÉÑ kÉqÉï xÉÉkÉlÉqÉç || Appeal to subscribers & Advertisers Please renew your yearly subscription. 2
  5. 5. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 UNILATERAL ACCESSORY HEAD OF THE BICEPS BRACHI – A CASE STUDY • Dr Giridhar M Kanthi ** Dr Parameswaran ** Dr Shakthi Kumar Abstract - out from the medial side of tendon to blend with deep fascia covering, the anterior compartment During our routine cadaver dissection in the Dept of the forearm. of Anatomy S D M College of Ayurveda Udupi, we found an accessory (third) head of the biceps Blood supply – brachi muscle in the left upper limb. This muscle Biceps brachi is supplied by eight vessels took origin just medial to the origin of Brachialis originating from the brachial artery in the middle on the middle of the shaft of the humerus and it is third of the arm. Smaller branches from the fused in the middle part of the biceps muscle and anterior circumflex humeral artery also supply continued along with rest of the muscle and gets muscle the Biceps. inserted into the radial tuberosity. The bicipital Nerve supply - apponeurosis is attached to the fibrous capsule of the elbow joint. The detail study was carried The Biceps brachi muscle is supplied by out in the presentation of the paper. Musculocutaneous nerve (c5, c6) Introduction - Additional points about Biceps Brachii The arm extends from the shoulder joint till the 1) Additional head of biceps. elbow joint. The Medial and lateral inter muscular a) When present the 3rd head of biceps, that septa divides the arm into anterior and posterior arises from the upper and medial part of compartments. The biceps brachi is one among brachialis, passes behind the brachial artery the muscles of anterior compartment of the arm. and is inserted in the medial side of the bicipital Since this muscle has two heads (one short head aponeurosis. At times the third head consists & one long head)usually, it is called as Biceps of two slips which pass in front and behind the Brachi. brachial artery. The short head of the muscle originates from the b) 4th head may arise from the lateral side of the tip of coracoid process of scapula in conjunction humerus from intertubercular sulcus. with the coracobrachialis. The long head of biceps 2) The tendon of the long head of Biceps may be originates as a tendon from the supraglenoid displaced from the intertubercular sulcus. tubercle of the scapula. The long head passes through the fibrous capsule of the gleno humeral 3) The tendon of insertion of biceps is twisted in joint superior to the head of the humerus. Then such a way that its anterior part is formed by it passes through the intertubercular sulcus and the short head and the posterior part by the enters the arm, the synovial membrane which long head. extend to the beginning part of the long head, Methods - so the fibrous capsule is not covers the region of During our routine cadaver dissection in the Dept tendon passes. In the arm the tendon joins with of Anatomy S D M College of Ayurveda Udupi we its muscle belly and together with the muscle found an accessory (third) head of biceps brachi belly of the short head overlies the brachialis muscles in the left upper limb of a 65 yr old male muscle. The long head and short head converge cadaver. A careful dissection was carried out to to form a single tendon which inserts on to determine its structure, including its attachments the radial tuberosity. As the tendon enters the and innervations. forearm, a flat sheet of connective tissue in the Observation form of aponeurosis (bicipital aponeurosis) trans • Dr Giridhar M Kanthi Prof & Head. ** Dr Parameswaran S & Dr Shakthi Kumar 3rd year P G in Anatomy S D M College of Ayurveda Udupi 3
  6. 6. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 The Accessory (third) head was situated deep from the anterior surface of the humerus distal to the short head of biceps on the middle of the to the insertion of the coracobrachialis muscle. shaft of humerus, originating just medial to the (6) Kosugi et al observed that the supernumerary origin of brachialis muscle. This muscle along head of biceps arose from the humerus between with the bellies of short and long heads was the insertion of coracobrachialis and the upper found to be overlying the brachialis muscle in part of the origin of brachialis are from the the arm. Later this muscle was inserted into the medial inter muscular septum.(9) The same radial tuberosity as forms the common tendon authors have also reported that in a few cases, along with the other two heads of Biceps, to the biceps brachii was seen to be arising blend with the deep fascia covering the anterior from the tendon of the pectoralis major, the compartment of the forearm. As far as bulk of deltoid, the articular capsule, or the crest of the muscle is concerned, this accessory head is greater tubercle.(9) Abu-Hijleh reported that the thin and short when compare with remaining supernumerary bicipital head originated from two bellies. This accessory head was having the anteromedial surface of the humerus just vascular supply from the branch of brachial below the insertion of coracobrachialis.(10) artery and was innervated by the branch from the Embryological observations by Testut described Median nerve rather than the common musculo this variation of the third head of biceps brachii cutaneous nerve. as a portion of the brachialis muscle supplied by Discussion the musculocutaneous nerve, in which its distal insertion has been translocated from the ulna Usually the Biceps will be having only two to the radius.(2)Knowledge of the existence of heads,Short head and a Long head. The the third head of the biceps brachii may become incidence of the third head of the biceps brachi significant in preoperative diagnosis and during muscle has been reported in several articles. surgery of the upper limbs. Therefore, surgeons, Gray’s Anatomy reported the incidence of this in particular orthopaedic surgeons, should be variation to be as much as 10%,(1) which aware of this anatomical variation when dealing concurs with the observations of Bergmanet with some of the clinical syndromes. in white Europeans.(5) Asvatet al reported an In the present case study an accessory (third) incidence of 21.5% in their study group consisting head was located deep to the short head of of blacks.(4)It appears that the incidence varies biceps, originating from anterior Medias surface among ethnic groups. Kopuzet al attributed the of the humerus and associated with the other two appearance of these variants to evolutionary bellies of biceps. It was found to be overlying or racial trends.(6)Santo Netoet al reported the brachialis muscle. This later merges with an incidence of 9% among blacks, which was the other two muscle bellies of biceps forming a significantly lower than the reported incidence for common tendon and gets inserted into the radial whites in his series.(7) Khaledpour contradicted tuberosity. The nerve supply is by median nerve Santo Netoetal’s results by comparing his series in this case, that may effect to the functions of to the results from other authors. He reported the third head that may or may not be associated that the third head of biceps brachii was rare in with other two heads function. The function may whites and relatively high among blacks. Asvatet defend on the basis of nerve innervations. The al observed that the third head of biceps brachii presence of this accessory head may result in originated from the humeral shaft either inferior the strong flexion at elbow joint and supination to, and in common with, the insertion area for of the forearm. the coracobrachialis, or in common with the brachialis muscle.(4) They also observed a dual REFERENCES origin in which the medial fibres originated from 1. Williams PL, Bannister LH, Berry MM, et al, the short head of biceps and the lateral fibres eds. Gray’s Anatomy: The Anatomical Basis from the deltoid fascia. According to Kopuzet al, of Medicine And Surgery, 38th ed. Edinburgh: the third head of biceps brachii frequently arise ELBS Churchill Livingstone, 1995: 843. 4
  7. 7. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 2. Testut L. En:Tratado de Anatomia Humana. Barcelona: Salvat, 1902. 3. Sargon MF, Tuncali D, Celik HH. An unusual origin for the accessory head of biceps brachii muscle. Clin Anat 1996; 9:160-2. 4. Asvat R, Candler P, Sarmiento EE. High incidence of the third head of biceps brachii in South African populations. J Anat 1993; 182:101-4. 5. Bergman RA, Thompson SA, Afifi AK. Compendium of Human Anatomic Variation: Text, Atlas, and World Literature. Baltimore:Urban and Schwarzenburg, 1988. 6. Kopuz C, Sancak B, Ozbenli S. On the incidence of third head of biceps brachii in Turkish neonates and adults. Kaibogaku Zasshi 1999; 74:301-5. 7. Santo Neto H, Camalli JA, Andrade JC, Meciano Filho J,Marques MJ. On the incidence of the biceps brachii third head in Brazilian white and blacks. Ann Anat 1998; 180:69-71. 8. Khaledpour C. [Anomalies of the biceps muscle of the arm].Anat Anz 1985; 158:79-85. German. 9. Kosugi K, Shibata S, Yamashita H. Supernumerary head of biceps brachii and branching pattern of musculocutaneous nerve in Japanese. Surg Radiol Anat 1992; 14:175-85. 10. Abu-Hijleh MF. Three-headed biceps brachii muscle associated with duplicated musculocutaneous nerve. Clin Anat 2005; 18:376-9. Fig.1 Shows accessory head of biceps brachi Fig.2 The accessory head along with long and short heads. Fig.3 Shows accessory muscle lies posterior to brachial artery 5
  8. 8. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 Primary Varicose Vein of Upper Limb – A Case Report* Dr. Sibgath Ulla Shariff. R. ** Kumari Aimon Sadaf, Kumar Anand Jaiswal, *** Guided by Dr. Giridhar Kanthi Kumar Arundeep.Abstract: Discussion:During routine dissection in the department of Primary varicose veins areanatomy, the unusual left Basilic vein varicosity the ones which develop duewas found. The left Basilic vein terminating as to intrinsic valvular incompetence & havethe Axillary vein, in its early course was found no apparent underlying cause. Secondarynormal. The varicosity was observed in the varicose veins due to outflow obstruction, valveupper part of the vein, just above the level ofelbow and just before the termination as the destruction and secondary deep vein thrombosisAxillary vein. This unique case of varicosity in the are because of arterio-venous fistulae. Due toBasilic vein gains tremendous importance in the the compression and improper flow of venouscontext of congenital vascular anomaly viz Klippel blood, it results in swelling in the arm, back ofTrenaunay syndrome and Park Weber syndrome. the scapula, and compression of the nerves inKeywords: Upper limb, basilic vein, varicosity. the axillary region.Introduction: Donogue & Leahy have quoted the prevalenceA varicose vein may be defined as a vein that of visible tortuous veins as 10-15% in males andbecomes elongated, dilated, tortuous & thickened 20-25% in females. The non Saphenous variesdue to continuous dilatation under the pressure. are nearly 45% in men & 50% in women.Primary varicose veins are common afflictionsof the lower extremities where as upper limb Clinical importance.veins are rarely affected. The literature has little Varicosity of the upper limb vein is a rarereference as regards the number of cases & phenomenon. The vein can cause compressionmanagement of upper limb varicose veins. of the surrounding structures which includeCase report: median nerve and medial cutaneous nerve ofThe left basilic vein varicosity was observed only arm.on the left arm during the routine dissection in a References:-female cadaver of about 50 years of age. Thebasilic vein in its early course was found running 1. onogue GO. Leahy A. varicose veins. Dupwards along the medial border of the forearm, Surgery 2002; 1:8-11.winding round the elbow, it then continuing 2. Rose SS, Ahmed A. Some thoughts on theupwards in front of the elbow & along with the etiology of varicose veins. J. Cordiovasc surg.medial margin of the biceps brachii muscle up 1986; 27:534-43.to the middle of the arm, where it pierced thedeep fascia and ran along the medial side of the 3. Clark DM. Warren R. Idiopathic varicose veinsbrachial artery up to the lower border of teres of upper extremity. N Engl J. Med. 1954;major where it continued as the axillary vein. The 250:408-12.course of the median cubital vein was as usual. 4. Welch HJ. Villavicencio JL. Primary varicose veins of upper extremity: A report of 3-cases. J. Vas. Surg. 1994; 20: 839 – 43. 5. Duffy DM, Garcia C, Clark RE. The role of sclerotherapy in abnormal varicose hand veins. Plast Reconstr surg. 2000; 106: 227-29. 6. Davis RP. Lipsing LJ. Connolly mark M. Flinn WR, varicose ulcer of the upper extremity surgery. 1985;98:616-8. * M.D (Anatomy) Lecturer, Dept of Anatomy. ** 1st year students MIAMS Manipal. Udupi. *** Prof. SDMCA,Udupi 6
  9. 9. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 ABSENCE OF PALMARIS LONGUS MUSC LE - A Case Report * Dr Seetharama Mithanthaya ** Anand Kumar Jaishwal, Aimon Sadaf, Arundeep,*** Guided Dr.Giridhar Kanthi Abstract: - During our routine dissection we in Japanese5 & Chinese population6, and it was found absence of the Palmaris longus muscle in about 1.02% in Ugandan population7. In Yoruba the left forearm. The arrangement of the other ethnic group of Nigeria, among 600 subjects, 40 flexor muscles was found normal. As the muscle (6.7%) individuals the Palmaris longus was found has less functional importance there may not absent and among them 23 (3.8%) were males be any functional deformity of the wrist joint. and 17 (2.8%) were female, the distribution on Tendon of the muscle is frequently used for the right and left were 2.3% & 3.4% respectively7. reconstructive surgeries. There is a growing interest in the existence of the Introduction: - Palmaris longus because its tendon is reported Palmaris longus is a slender fusiform vestigial to be most frequently harvested for constructive muscle situated between the flexor carpi radialis plastic and hand surgery. Palmaris longus tendon and flexor carpi ulnaris and it is counted among is used for repair of ptosis in children. Palmaris the superficial flexor muscles of the forearm. The longus is most popularly used in tendon graft of muscle takes origin from common flexor origin wrist due to its length and diameter and the fact (medial epicondyle of the humerus), from adjacent that it can be used without producing structural intermuscular septa and antebrachial fascia. Its deformities and using patient’s own tendon is long flexor tendon passes anterior to the flexor advantageous. In case Palmaris longus muscle retinaculum and gets inserted in to the distal 1/3rd is absent for harvesting in an individual, the of its anterior surface and centrally to palmar anatomically homologous plantaris muscle in the aponeurosis. The muscle is supplied by median leg may be used8. nerve (c7-8)1. Palmaris longus can be palpated by Conclusion: - touching the pads of 5th and 1st fingers and flexing Palmaris longus is a slender muscle in the flexor the wrist, the tendon, if present, will be visible. This compartment and is frequently found absent test is known as schaeffer’s test2 (fig 3). with incident rate of about 15%. The tendon of Case report: - the muscle is commonly used for reconstructive During the routine dissection for undergraduate surgeries and tendon grafts. So the surgeons students at Muniyal Institute of Ayurveda Medical should keep this information about frequent Sciences, we found absence of Palmaris longus absence of Palmaris longus prior to the surgery muscle in the left forearm in a male cadaver, and its presence can be easily examined by about 55 years age. Arrangement of other flexor performing schaeffer’s test. muscles and attachment of flexor retinaculum were found normal (fig 1, 2). Discussion: - Palmaris longus is a weak flexor of wrist and is Flexor carpi ulnaris Flexor digitorum considered functionally negligible. The prevalence Superficialis brachioradialis of the agenesis of the muscle as reported in Flexor retinaculum most of the anatomy text books is about 15%. Flexor carpi radialis A higher incidence (24%) was reported in North Radial artery American population3. Ceyhan & Mavt reported a much higher prevalence agenesis (63.9%), in the Gaziantep population in turkey4. The incidence Fig 1: Muscles of flexor compartment of left was found in about, 3.4% & 4.6% respectively forearm * Lecturer, Dept of Shareera rachana, ** 1st year students. MIAMS Manipal, Udupi Karnataka. *** Prof. SDMCA,Udupi 7
  10. 10. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 Flexor carpi ulnaris Flexor Carpi radialis Flexor digitorum Superficialis Ulnar nerve Flexor digitorum Superficialis tendon Flexor reinaculum Fig 2: Muscles of flexor compartment of left forearm Palmaris longus tendon Palmaris longus tendon Fig 2: Schaeffer’s test demonstrating the presence of Palmaris longus. Bibliography 5. Adachi B. Beitrage zur Anatomiae der japaner. 1. Henry Grey. Editor: Williams PL, Warwick R XII. Die Static der Muskelvarietaten zweite et al. Grey’s Anatomy. 38thed. 1995. Churchill Mitteilung. Zeitsch F Morphol Anthropol Bd Livingston; Newyork. P: 846, Pp2091. 1909; 12:261-312. 2. S A Roohi et al. A study on absence of Palmaris 6. Sebastin SJ, Puhaindran ME, Lim AY, Lim IJ, logus in a multi-racial population. Malaysian Bee WH. The prevalence of absence of Palmaris Orthopaedic Journal 2007 Vol 1 No 1. longus – A study in a Chinese population and a review of literature. J Hand surg (Br 2005; 30 3. Troha F Baibak GJ, Kellehr JC. Frequency (5): 525-7. of Palmaris longus tendon in North American Caucasians. Ann Plast Surg 1990; 25(6): 7. Igbigbi PS, Sekitoleko HA. Incidence of agenesis 447-8. of the Palmaris longus muscle in Ugandan population. West African J Anat 1998; 6:21-3. 4. Ceyhan O and Mavt A. Distribution of agenesis of Palmaris longus muscle in 12 to 15 year age 8. Thejodhar P, Bhagat Kumar Potu, Rakesh G, groups. Indian J Med Sci 1997; 51(5):156-60. Vasavi. “Unusual palmaris longus muscle”. Indian Journal of Plastic Surgery 41.1 (2008) :95-96. Pubmed. Web. 3 Dec. 2009. 8
  11. 11. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 “NATIONAL CONFERENCE” Annavaha shrotho shareera on 15th October 2011 Report (organized by “Shree Jagaddaguru Gavishiddeshwar Ayurvedic Medical College P.G. Studies and Research Centre, Koppal) National Conference of Shareera Rachana prestigious award in the field of Ayurveda. In the (Anatomy) held at koppal on 15th October 2011 same occasion for giving moral support to son his organized by shree Jagdguru Gavishiddeswar mother Dr. Sushiladevi Ramannavar felicitated Ayurvedic Medical College P. G. Studies and by His Holiness, M.N.P.S Shree Jagadguru Research Centre Koppal, in association with Gavisiddheshwar Mahaswamiji, Koppal, Shree All India Shareera Reaserch Institute karnataka S R Navali Hiremath Chairman SJGAMC&H S D M College of Ayurveda Hassan Karnataka Koppal with Governing Council Members of Regional Branch, with blessings of Poojya AISRI Karnataka regional branch Hassan. 17th Shree Ma. Ni. Pra. Swa. Jagadguru Abhinava century sir William Harvey dissected her sister Gavisiddheshwar Mahaswamiji Shree Gavimath body but Dr. Mahantesh Ramannavar contributed Koppal, to field of anatomy from India on 13-11-2010,by Dr. V V Doiphode Ex Dean Pune University, dissecting his own father body as committed Dr. V. S. Shirol Prof & Head JNMC Belgaum, Dr. teacher, also motivating public for Eye and Body Mukunda Erende Prof S S Ayurveda Medical donation, College Hadapsar Pune, Dr. Adinarayana Prof Every year AISRI Karnataka regional branch & Head A L N Rao Govt Ayurveda Medical Hassan honoring the students who secured College Warangal, Dr. Giridhar M Kanthi Prof highest marks in the Shareer Rachana and S D M College of Ayurveda udupi delivered the kriya subjects, first three rank students, in the guest lectures on the different topics of Annavaha annual examination of RGUHS Bangalore, Srotas and its clinical anatomy. Dr. Sushiladevi Ramannavar president Dr Nearly about 300 delegates were participated Ramannavar Charitable Trust Bailhongal has the conference from Ayurvedic Colleges of given Dr. B. S. Ramannavar memorable GOLD Karnataka. P.G Scholars of different faculties MEDAL to the students of 2009/10 and 2010/11 were presented scientific papers on Annavaha batch who secured highest marks in Shareera srotas and its clinical applications. Rachana (Anatomy) subject from Rajiva Gandhi University of Health Sciences Bangalore. Every year AISRI Karnataka regional branch Hassan will honoring the senior teachers who Dr. B. S. Ramannavar memorable GOLD dedicated their service in the field of Shareer MEDAL bagged by to the following students, from Karnatak, this year Dr. S A Patil retired Prof and honored by Dr. Sushiladevi Ramannavar of anatomy Bijapur. Dr. K B Hiremath Prof Vice president Dr B S Ramannavar Charitable Trust Principal S J G Ayurvedic Medical College koppal Bailhongal were honored as “Best Shareera teacher award 1. 08A7429 Kumara Nandeesha N 333 Marks 2011” with cash prize of five thousand rupees, highest in Shareer Rachana year 2009/10 Dr. Mahantesha Ramannavar Asst. Prof KLE’s Sri Raghavendra Ayurvedic Medical College, BMK Ayurveda Nahavidyalaya honored as “Best Malladihally Dist – Chitradurga Young Anatomy Teacher award 2011” with cash 2. 09A0170 Kumari Sushobhitha M 342 Marks prize of rupees five thousand, and citation with highest in Shareer Rachana year 2010/11 certificate and memento for creating the history Shri Dharmasthala Manjunatheshwara in the field of medical science after sir William College of Ayurveda, Hassan. Harvey. He is the first person to receive this 9
  12. 12. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 SUPERFICIAL VENOUS VARIATION OF THE UPPER LIMB – A CASE REPORT **Dr. Giridhar M. Kanthi. *Dr. Vidhyaprabha R. INTRODUCTION and by 2 dorsal digital veins of the thumb on The superficial veins of the upper limb are its lateral side. On the medial side it receives a clinically important as they are most commonly dorsal digital vein from the ulnar side of the thumb. used for veini puncture, transfusion and cardiac The dorsal digital venous plexus is then drained catheterization. Mostly the superficial veins are by the cephalic and basilic veins on the radial and considered for these purposes, the following four ulnar sides’ respectively2. veins are includes1 Cephalic Vein: 1. Cephalic vein Cephalic vein usually forms over the anatomical 2. Basilic vein snuff box from the radial end of the dorsal venous 3. Median cubital vein arch. It curves around the radial side of distal 4. Dorsal digital network (Dorsal venous arch) part of the forearm to reach the ventral aspect and ascends. Just below the elbow it often gives The increasing use of parenteral route for various a branch, the median cubital vein, to the basilic emergency and critical therapies has made vein. It further ascends between brachioradialis it essential that every physician has correct and biceps brachii muscles and reaches the anatomical knowledge of superficial veins of the deltopectoral groove. It pierces the clavipectoral upper limb is necessity in the field of medical fascia, crosses the axillary artery and joins the science. axillary vein2. Many authors have reported variations in the Basilic Vein: course of superficial venous drainage of the It begins from the medial end of the dorsal venous upper limb, mostly mentioned are the variations plexus. It runs upwards and winds round to the of cephalic vein and dorsal venous arch. We ventral surface of forearm near the elbow and observed a variation of the superficial veins of continues upwards along the medial margin the upper limb during routine dissection. The of biceps brachii, pierces the deep fascia and dorsal venous arch had a variation in its site and continues as the axillary vein from the lower the cephalic vein and accessory cephalic veins border of teres major muscle2. had a variant. Median Cubital Vein: REVIEW OF ANATOMY – It is a large communicating vein in the cubital fossa. It begins from the cephalic vein 2.5 cm Dorsal Venous Arch: below the bend of the elbow, runs obliquely The superficial venous drainage of the digits is upwards and medialy and ends in the basilic by the dorsal digital veins which pass along the vein 2.5 cm above the medial epicondyle. It may sides of fingers. They unite to form the dorsal receive branches tributaries from the median digital metacarpal veins which plays a key role vein of the forearm and is connected to the deep in the formation of the dorsal venous arch (dorsal veins through a perforator vein which fixes the venous network) in the region of the head of median cubital vein making it ideal for intravenous metacarpal bone. This is joined by the dorsal injection2. digital vein from the radial side of index finger ** Prof,SDMC Udupi *Anatomy 3rd year P G Scholar Alva’s Ayurveda Medical College, Moodabidri 10
  13. 13. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 Accessory Cephalic Vein: It is an accessory vein which is sometimes present. It drains the blood from the dorsal part of the forearm. Usually it ends by joining the cephalic vein near the elbow2. OBSERVATION: During a routine dissection done on an Indian male cadaver of an estimated age of 50 years, a variation of the anatomical presentation of veins was noted on the left upper limb, especially the cubital region and dorsal surface of the forearm and hands. The anatomy of the veins on the right 5 side was as usual. 1 2 1 4 3 1 4 1 2 ANTERIOR VIEW: 1- Cephalic vein, 2- Branch of accessory cephalic vein, Type, 3- Median cubital vein, 4- Basilic vein, 5- Median vein of the forearm. 3 Dorsal Venous Arch: In this case the digital veins unite to form dorsal metacarpal veins, but they do not form 4 a network in the usual anatomical site of head of the metacarpus. The dorsal metacarpal 5 veins run forward straight beyond the wrist till the dorsal surface of distal part of forearm and 6 form a venous network at this site. The dorsal venous arch extends over the dorsal surface of the forearm as well as to the ventral part of the POSTERIOR VIEW: 1- Dorsal digital vein, 2- forearm on the lateral side. The cephalic vein and Dorsal metacarpal vein, 3- Dorsal venous arch, basilic vein begins from the lateral and medial 4- Basilic vein, ends of the above mentioned venous network. 5- Accessory cephalic vein, 6- Branch of accessory cephalic vein Basilic Vein: It begins after the distal 1/3rd of the forearm. It courses up and passes on to the ventral surface in the middle of the forearm. 11
  14. 14. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 Cephalic Vein: It begins at the lateral end of the dorsal venous CONCLUSION: arch on the ventral surface of the forearm where the dorsal venous arch receives the 2 digital veins The most commonly used veins for intravenous from the thumb. It passes up and just below the infusions are the superficial veins of the cubital cubital fossa it receives the median vein of the fossa. In this region the brachial artery lies forearm and gives away a branch the median deeper to the median cubital vein separated from cubital vein which joins the basilic vein. Further it only by the bicipital apponeurosis. Inadvertent it courses up as a thinner blood vessel. In the passage of needle in this region may allow it to region of the cubital fossa it receives a branch of pierce the apponeurosis and the brachial artery. the accessory cephalic vein and moves up in the Some drugs may cause unwanted reactions normal anatomic course. when given intra arterially or peri arterially. Taking in to consideration such complications Accessory Cephalic Vein: which may even occur in accidental puncture, This vein is seen as an extension from the middle some physicians prefer superficial veins of the of the dorsal venous arch. It courses up and dorsal digital plexus. In this location arterial below the elbow gives off a branch which joins abnormality will be of a lesser degree of concern the cephalic vein. Further it moves upwards and as opposed to the anti cubital fossa1. In recent ends by joining the cephalic vein below the delto time, the clinicians prefer the superficial veins of pectoral groove. the forearm for intravenous infusions. An attempt to access these veins in a state of such variations DISCUSSION: could result in difficulty to access, movement in A variation of the superficial veins of the forearm the wrong direction and also may cause puncture usually comes across during routine dissection. wrong of area or structures in the related region. Some such reported variations are discussed Therefore, the knowledge of the anatomical below. variations would help to reduce the occurrence of the iatrogenic complications. Cephalic vein sometimes joins with external jugular vein to form a common trunk which ends REFERENCE in the axillary vein3. Median vein of the forearm 1. Gaither B. Everett, Gerald D. Allen. Intravenous begins from the palmar venous network and therapy – A review of site selection and ends in any one of the veins in front of the elbow, technique, Anesthesia Progress, November the basilic, cephalic, or median cubital vein. 1969 Sometimes it divides into median cephalic and median basilic veins which join the cephalic and 2. B. D. Chaurasia. Human Anatomy 4th Edition basilic veins respectively; this pattern replaces Vol I. Published by Satish Kumar Jain for CBS the median cubital vein2. It has been reported Publishers & Distributors. New Delhi. 2004. that digital veins of the fingers drains in to the p. 70,71 metacarpal veins which has variable size and location with free anastomosis1. The accessory 3. Deog Im Kim. Venous variations in neck cephalic veins originate either from a venous region: cephalic vein. Variant veins in the plexus on the dorsum of the forearm or from the neck. September 2010 medial aspects of the dorsal venous arches4. 4. Robert J. Amitrano, Gerard J. Tortora. The cephalic and basilic veins are connected by Laboratory Exercises in Anatomy and the median cubital vein in 70% of subjects. The Physiology with Cat Dissections 8th Edition, whole cephalic vein drains into the basilic vein Published by Thomson Brookes/Cole, 2007, in 20% of cases. The cephalic and basilic veins P.450 remain separate in 10% of subjects2. 12
  15. 15. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 Congratulations and Best Wishes from AISRI Regional Branch Hassan Awarding the 4th Rank in Shareera Kriya 1st year BAMS of RGUHS Bangalore Kum. Chaitra N 2nd year BAMS, SDMA, Udupi D/o. A. Nagaraj It is no fault of the student because a year has only 365 days. Days in a year = 365 days Sundays = 52 days (Sundays are meant for rest) Days left = 313 days Summer Vacations = 60 days (Weather is very hot, so it is difficult to study) Days left = 253 days Eight hours of daily sleep = 122 days (Necessary) Days left = 131 days One hour daily for play = 15 days (It’s good for health) Days left = 116 days Two hours for daily food = 30 days (Chew the food properly, don’t care for time) ays left = 86 days D Examination days in a year = 30 days (Giving exams is necessary) Days left = 56 days Winter vacations = 25 days (Weather is cold, it’s difficult to study) Days left = 31 days Other holidays = 20 days (These holidays are to enjoy) Days left = 11 days Illness at least once a year = 8 days (Because of illness, study is difficult) Days left = 3 days Result days = 3 days (Going and taking result is necessary) Days left = 0 days So, tell me where is time for study?! Body Donar Principal and Department of Anatomy S D M College of Ayurveda Udupi will be appreciated to Smt. Mainavathi Koppar for her Body Donation after the death Name : Smt. Mainavathi W/o. Krishna Acharya Koppara Age : 77 Years Add : At post - Kallapur, Taluk - Hanagal Dist. - Haveri 13
  16. 16. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 Regimen during Winter Season *Dr. Vinay Bhardwaj ** Dr. Hem Raj Meena Introduction:- 6. Cold and unctuous environment lead to In Ayurveda, six seasons has been building up of excess phlegm in body. described as summer season, rainy season, 7. Usually in India, it is observed during Autumn season, winter season, spring season months of November-December. & decoy season. Long nights, short days, 8. Less humid & more cool air blows in sparkling snow flakes and people dressed in winter. warm clothes are the images evoked for the word 9. All directions are covered by fog & winter. The winter season is marked as Hemanta aerosols. ritu in ayurveda. Hemanta ritu starts from mid November and ends in mid January. This falls 10. Pounds are covered by snow. in southern solastice which is called as Visarga 11. Water evaporates from water surfaces. kala or dakshinayana in ayurveda. hot vapors come out from hand pump Winter causes health problems when water. adequate precautions and safety measures are Physiological changes not taken. But winters can be enjoyed to full 1. Sanchaya of kapha & Shaman of vata occurs extent when we alter our diet and lifestyles a little in hemant ritu(winter season). as nature desires (Ritu satmaya).All seasons are 2. In winter the Jatharagni ( agni or body fire) responsible for sanchaya, prakopa & shaman of increases with the support of vata . which doshas- Vata, Pitta & Kapha. can digest dravya guru(heavy) & matra Characteristics. guru(more quantity) food easily. 1. Earth moves away from sun closer to 3. Hence there will be a marked increase in moon during this period(dakshinayan appetite. The frequency of food consumption kala) increases. In absence of sufficient diet 2. Environment is therefore cold and increased digestive fire may cause variety unctuous during this season and cold of health problems and reduce strength and breeze flows. vitality of body 3. Cold and refreshing climate helps in 4. Skin is bound to become dry and irritated. increase of digestive fire. . Dry skin tends to crack and bleed. Cracked 4. Cooling effect of climate as also skin looses its ability to protect the body and increased overall nourishment due to increases the risk of infection. increased appetite leads to increased 5. weight gain (Bala vriddhi), mild depression, strength and vitality of body. irritability and short temper. 5. Nights are long and day short during this This condition is well marked in persons who live period. in places which experience long severe winter. * P.G. Scholar, Sharir-Kriya Deptt., National Institute of Ayurveda ** Asst. Prof., Sharir-Kriya Deptt., National Institute of Ayuveda. 14
  17. 17. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 11. Use of sweet, sour fruits like apple, 4. Apply lip balm to prevent cracking custard apple, hog plum, banana, dry 5. Twenty to 30 minutes of aerobic exercise fruits etc is beneficial. three times a week can give your skin a 12. Heavy breakfast during morning is healthy glow. advisable as digestive power is high. 6. Ayurveda stresses on massaging body Diet to be avoided with oil (tail malish) 1. Use of food dry in nature and light to 4. Mix few drops of coconut oil in little digest (laghu) like biscuits, bread or water. Rub this all over body at the end cereals like and grains like barley, gram, of bath or shower. spiked dolichos etc should be avoided 5. Always wear warm clothes. during winter. 6. Regular use of full body oil massage is 2. Use of diet in very low quantity or very much helpful to keep away cold. reduced frequency of diet is not at all Oil should be hot in nature or prepared advisable. from medicines that are hot in nature like 3. Food which is not fresh and cold in nature sesame oil, mustard oil etc. Also more like frozen food, overnight food should be pressure and friction should be applied strictly avoided. during massage. 4. Use of cold refrigerated water, soft 7. Herbal powders of pine tree. Acorus drinks, cold fruit juices, milkshakes etc calamus etc could be applied over body is also not advisable (vata vitiated food). after massage as these are hot in nature. 5. Avoid consumption of junk foods, (ubtan) 6. Too much of sweets and oil food as 8. Also use of sudation therapy(jentak swed these lead to obesity (sthaulya) therapy) like herbal steam bath etc is very 7. Sattu (mixture of oat, wheat & chana) much useful to reduce impact of cold. prepared with water. 9. Use of hot water is must for bath. Non dietary measures 10. Environment at home and work should be warm and cozy with use of room heaters, 1. Exposing our body to sunlight chimney fire etc. 2. Exercising (vyayam) for 30 minutes 11. Use of warm bed sheets during sleeping is and using bright light when you are useful. Cotton plug in ears could be used indoors to reduce Impact of cold. 3. The best ways to keep the skin soft, 12. Use of proper footwear including use of healthy and moisturized are sleepers, socks etc even at home to avoid I. Avoid long hot showers and bath. contact of feet with cold. II. Quick three minutes bath is 13. Exercise for longer durations could be advisable. carried out especially jogging and warm- III. Use moisturizing body wash. up exercise. Use of ‘Praanaayaama-Yoga’ IV. Apply petroleum jelly on tough areas is beneficial to keep body warm and guard like knees, elbows and heels. against cold and should be carried under expert guidance. Also sporting events like 15
  18. 18. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 wrestling is useful. water in winter due to less thirst. 14. Due to cold and refreshing climate, 2. Avoid long hot showers and bath. Use luke frequency of sexual intercourse can be warm water instead of hot water to wash the maximum during this season. face. Apply moisturizer lotion if you feel 15. Avoid sleeping during afternoon. dryness on skin. Apply sun screen lotion to exposed parts of body and face when you goSusceptibility for diseases out in sun1. Hypothermia -drop in body temperature to 3. In ayurveda it is advised to drink hot water, 95 deg. Fahrenhite or less. Person affected wear warm clothes and to stay near fire place by hypothermia will be having symptoms at indoors in winter to prevent hypothermia. like shivering, drowsiness, slurred speech, week pulse, slow heart beat, slow and shallow 4. Preventing cold and cough in winter. breathing. If the body temperature falls down Consume well balanced good nutritious food, below 86 F he may slip into coma. exercise thrice in a week and sleep well to keep up natural resistance. Avoid direct2. Frostbite - The exposed areas of body like contact with those who have colds and wash face, feet, wrists and hands are affected your hands frequently. by frost bite. The skin on the affected part becomes white, stiff and feels numb. 5. Most of your body heat is lost through your head so wear a hat, preferably one that covers3. obesity- due to excessive eating & wt. gain your ears.4. Heart diseases-Increases in heart disease are 6. Wear waterproof, insulated boots to help avoid also noted at very cold temperatures as well. hypothermia or frostbite by keeping your feetPrecautions- warm and dry and to maintain your footing in1. Protect your Tiny tots from cold. ice and snow. Children are usually thrilled to go o utside 7. Recognize the symptoms of hypothermia that irrespective of weather conditions. To ensure can be a serious medical condition: confusion, that these tiny tots have a safe and fun winter, dizziness, exhaustion and severe shivering. take some simple measures to keep them warm Seek medical attention immediately if you and unharmed both inside and outside. Ensure have these symptoms. that they stay warm while waiting for school 8. Recognize frostbite warning signs: gray, bus in low temperature conditions. Keep them white or yellow skin discoloration, numbness, as dry as possible in cold weather and make waxy feeling skin. Seek medical attention them to wear properly fitting warm clothes. immediately if you have these symptoms. Cover their head, face and neck as much as Warm the affected parts gradually. Wrap the possible. Inadequate head protection lead to area with warm clothes or keep the affected loss of almost half of body heat. Don’t allow hands under arm pits and seek the medical them to overexert and sweat. Sweating cools attention immediately. Do not rub the affected the body which is hazardous in winter and it areas as it may damage the underlying becomes difficult to warm up again. Keep them tissues. well hydrated as they may not drink sufficient 16
  19. 19. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 Variation in Flexor digitorum superficialis (sublimis) – A case study * Dr. Sharath.S.G, Dr. Maya Mukundan Dr. Vidhyaprabha. R Dr. Anjana. V Dr. Poojarani. *** Dr. Shubada. V. I. Guided by **Dr. Giridhar. M. Kanthi. Abstract The variations of Flexor digitorum superficialis Flexor digitorum superficialis is the largest are found out during our routine cadaver among the five superficial muscles of flexor dissection. There are two different kinds of compartment of forearm. It arises by two heads variations found. Many authors have reported (humero-ulnar & radial). The variations in this variations in its origin, appearance, additional muscle are not uncommon. Around twenty- slip, accessory muscle, absence of one head, four different variations are identified by now. absence of tendon to the little finger, etc. These variations will have no role in altering the normal action of the muscle (Flexor digitorum Review of Anatomy: superficialis is a potential flexor of proximal Muscles of the superficial flexor compartment interphalangeal, metacarpo-pahalangeal and arise from the medial epicondyle of the wrist joints). The variations which we found humerus by a common tendon. As above during our dissection are completely new. mentioned, there are five superficial flexor Surprisingly there are two different kinds of muscles in forearm region. variations in both sides (Right & Left). There is an additional slip on both sides, but in right side, Flexor digitorum superficialis (sublimis): there is a digastric appearance of radial head of Even though it is a muscle of superficial flexor Flexor digitorum superficialis. group of forearm, it lies deeper to the preceding Key words : Flexor digitorum superficial is muscles. It is the largest of the superficial additional slip, digastrics, flexors, Introduction: The forearm comprises of two sets of Origin: arises by two heads, the Humero-Ulnar musculature, anterior or flexor group and head arises from the medial epicondyle of posterior or extensor group of muscles. Each of humerus via a common tendon; the anterior these groups is divided into superficial and deep band of the ulnar collateral ligament; adjacent sets again. The flexor group has five superficial intermuscular septa, and from the medial side and three deep muscles. These flexor muscles of the coronoid process proximal to the ulnar flex the forearm at elbow and wrist; some of them origin of pronator teres. The Radial head is even flex the fingers (metacarpo-phalangeal and a thin sheet of muscle which arises from the interphalangeal joints). anterior radial border extending from the radial tuberosity to the insertion of pronator teres. The flexor compartment of forearm The median nerve and ulnar artery descend Superficial Deep between the heads. The muscle usually 1.Pronator tere 1.Flexor digitorum separates into two strata, directed to digits 2-5. profundu The superficial stratum, joined laterally by the 2.Flexor carpi radialis 2.Flexor pollicis longus radial head, divides into two tendons for the middle and ring finger. The deep stratum gives 3.Flexor digitorum 3.Pronator quadratus off a muscular slip to join the superficial fibres superficialis directed to the ring finger, and then ends in two 4.Palmaris longus tendons for the index and little finger. As the 5.Flexor carpi ulnaris tendons pass behind the flexor retinaculum they * PG scholars, Dept.of Shareera Rachana, Alva’s Ayurveda Medical College, Moodbidri, Karnataka, India. ** Professor & H.O.D , SDM college of Ayurveda, Kuthpady, Udupi, Karnataka, India. *** Asst.Professor , Department of Shareera Rachana, Alva’s AMC, Moodbidri, Karnataka, India 17
  20. 20. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 are arranged in pairs: the superficial pair pass independent muscle slips to all four fingers, to the middle and ring fingers, the deep to the unlike flexor digitorum profundus, which has index and little finger. Distal to the carpal tunnel a muscle group common to the middle, ring the four tendons diverge. Each passes towards and little fingers. It is therefore able to flex the a finger superficial to the corresponding flexor proximal interphalangeal joints individually. digitorum profundus tendon. The two tendons for Brachial artery each finger enter the digital flexor sheath (which Median Nerve Common Fascia starts over the metacarpophalangeal joint) in Radial Nerve this relationship. The superficialis tendon then Bicipital aponeurosis Ulnar artery splits into two bundles which pass around the Posterior Interosseous Nerve Supinator profundus to lie posteriorly. They subsequently Arcade of froshe Pronator teres reunite and insert into the anterior surface of the Brachioradialis middle phalanx. Some fibres interchange from Radial artery Flexor carpi radialis one bundle to another. Palmaris longus Flexor carpi ulnaris An intermediate tendon is always found in the central branching area of the muscle belly and Flexor digitorum superficiali (radial head) is an important landmark in deep dissection: it Flexor digitorum superficiali can initially be confused with the median nerve. Abducto pollicis longus The radial head of flexor digitorum superficialis may be absent and the muscular slip from the Radial artery deep stratum may provide most or all of the fibres acting on the index finger. The fibers associated Median nerve with the little finger may be absent, when they are Ulnar artery Ulnar nerve replaced by a separate slip from the ulna, flexor Flexor retinaculum Abductor pollicis brevis retinaculum or palmar fascia. Variations occur in Guyo’ns canal the arrangement of the tendons. Flexor pollicis brevis Palmaris brevis Relations: The median nerve and ulnar artery descend between the heads of flexor digitorum Adductor pollicis superficialis. Palmar aponeurosis Vascular supply: The humeral head of flexor Fig 01 – The superficial flexor muscles of forearm digitorum superficialis is supplied by the anterior Observation : ulnar recurrent artery. The main part of the muscle is supplied on its anterior surface by As a part of the routine dissection done on an three or four branches from both the ulnar and Indian male cadaver aged about 50 years, it was radial arteries. The posterior surface is supplied observed to have some discrepancy in the flexor by the ulnar artery and median artery, and the compartment muscles of forearm. An additional lateral surface by additional branches from the slip of muscle was found to connect Flexor radial artery. digitorum superficialis with Flexor pollicis longus, bilaterally. A digastric appearance of a portion of Innervation: Flexor digitorum superficialis is Flexor digitorum superficialis was also observed innervated by the median nerve, C8 and T1. on the right forearm. Action: Flexor digitorum superficialis is potentially Bilateral Additional slip : a flexor of all the joints over which it passes, i.e. proximal interphalangeal, metacarpophalangeal The occurrence of additional slip of muscle was and wrist joints. Its precise action depends found bilaterally, but there was difference in the on which other muscles are acting. It has attachments of the slip on both sides. 18
  21. 21. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 In the right forearm, the slip is attached Relations: proximally to the lateral part of Flexor digitorum The additional slip crossed the Ulnar artery superficialis and Ulnar head of Pronator teres superficially. Median nerve and humeral head of close to its proximal attachment and distally to Pronator teres were superficial to the additional the Tendon of Flexor pollicis longus in the upper slip. half of forearm. In the left forearm, the slip has The relations on right forearm: its proximal attachment on lateral part of Flexor Anteriorly- Humeral head of pronator teres, digitorum superficialis 5 cm from its origin and Median nerve distal attachment on the tendon of Flexor pollicis Posteriorly- Ulnar artery in the upper part, Flexor longus in the middle of the forearm. digitorum profundus Medially- Flexor digitorum superficialis, Ulnar Digastric appearance of a portion of Flexor artery in the lower part digitorum superficialis : Laterally- Ulnar head of Pronator teres Humero-ulnar head of the muscle had two Relations on left forearm: separate portions, of which the lateral portion Anteriorly- Humeral head of pronator teres, was found to have a digastric appearance. The Median nerve intermediate tendinous portion was proximal to Posteriorly- Ulnar artery in the upper part, Flexor the middle third of the forearm. digitorum profundus Medially- Flexor digitorum superficialis, Ulnar Nerve supply: artery in the lower part The additional slip did not show to have any Laterally - Humeral head of Pronator teres, Flexor separate nerve supply. pollicis longus in the lower part. Relations of the additional slip Right forearm Left forearm Anterior Humeral head of pronator teres, Anterior Humeral head of pronator teres, Median nerve Median nerve Posterior Ulnar artery in the upper part, Posterior Ulnar artery in the upper part, Flexor digitorum profundus Flexor digitorum profundus Medial Flexor digitorum superficialis, Medial Flexor digitorum superficialis, Ulnar artery in the lower part Ulnar artery in the lower part Lateral Ulnar head of Pronator teres Lateral Humeral head of Pronator teres, Flexor pollicis longus in the lower part 19
  22. 22. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 Discussion and Conclusion: The flexor compartment of forearm has five superficial and three deep muscles. An intermediate tendon is always found in the central branching area of the muscle belly and is an important landmark in deep dissection and it can initially be confused with the median nerve. The radial head of flexor digitorum superficialis may be absent. Variations occur in the arrangement of the tendons. The additional slip noted in the present dissection was a connection from the superficial Flexor digitorum superficialis to the deep Flexor pollicis longus. The additional slip didn’t have any separate nerve supply, which confirms that it is a part of the Flexor digitorum superficialis. So action of the muscle is also not different. The presence of digastric mode of arrangement Fig 03- Additional slip of muscle in left forearm of the portion of Flexor digitorum superficialis is flexor compartment. also a rare finding encountered. References: 1. Chaurasia . B.D. Human Anatomy Vol.1: Bangalore: CBS publishers and distributors; 4th edition. 2004. 2. Henry Gray. Gray’s Anatomy: Edited by Susan Standring. UK: Churchill Livingstone, Elsevier; 40th edition. 2008. 3. Romanes. G.J. Cunningham’s Manual of Practical Anatomy Vol.1; Oxford: Oxford University Press; 15th edition. 2008. 4. Anatomy Atlases. A digital library of anatomy Fig 04 – Additional slip and Digastric information. Flexor Digitorum Superficialis appearance of Flexor digitorum superficialis in (Sublimis) [internet] 2011. [cited – 2011 right forearm flexor compartment. December 4th ]. Available from: http://www.anatomyatlases.org/ 20
  23. 23. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 After 25 Years In Woman’s Stomach, A Pen Still Writes by SCOTT HENSLEY and MELISSA FORSYTH EnlargeCourtesy of BMJ Case Reports EnlargeCourtesy of BMJ Case Reports A pen removed from a woman’s stomach after 25 years still works. CT scan proves woman was right. She did swallow a pen 25 years ago. You might have heard about the case on Wednesday’s Morning Edition. Twenty-five years ago, a British woman who saw a spot on a tonsil tried to get a better look using a pen and a mirror. She slipped and the pen went down her throat. Neither the woman’s husband nor her doctor believed her. X-rays at the time didn’t detect the pen. Now, “they are eating their words,” as NPR’s Linda Wertheimer put it. A CT scan shows she was right. And the woman, 76, had the felt-tip pen removed. Even after all these years without trouble, doctors figured there was a risk the pen could tear a hole in her stom- ach. Remarkably, the pen still worked. Take a look for yourself at the scan showing the pen in her stomach. And the acid test, so to speak, “Hello,” written with the retrieved pen afterward. The images come courtesy of BMJ Case Reports, a peer-reviewed clearinghouse for quirky and significant cases, that has become one of our favorite reads. The journal kindly gave us permission to reproduce the images. For more, see the case report: “An incidental finding of a gastric foreign body 25 years after inges- tion.” Beyond being a bit bizarre, the case does have a few lessons for clinicians, the reporting doctors write: “plain abdominal X-rays may not identify ingested plastic objects and occasionally it may be worth believing the patient’s account however unlikely it may be.” Courtesy by Internet Medical news and BJM 21
  24. 24. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 emerylogical Development of Testis • Testis Develops from Coelomic epithelium • Genital ridges form first. • Sex cords are formed by the cells of germinal epithelium. • Sex cords reach deep into the gonad to from Medullary cords • Canalization occurs and Seminiferous tubules are formed. • Interstitial cells of testis are derived from sex cords and are not canalized. • Tunica albuginea is formed from mesenchymal cells surrounding testis. • Ends of seminiferous tubules anastomose to form Rete testis. • Rete testis along with mesonephric tubules forms Vasa efferentia. • Cranial part of mesonephric duct form Epididymis. • Caudal part forms Ductus deferens . • Seminal vesicles arise as a diverticulum from lower end of mesonephric duct. • Part of mesonephric duct which lies in between the prostratic urethra and diverticulum forms Ejaculatory duct Development of Ovary • Coelomic epithelium of mesonephros form genital ridges. • Sex cords proliferate from germinal epithelium. • Primordial germ cells migrate to the region of developing ovary to form Oocytes. • Sex cords are broken up into masses and surround primordial germ cells to from Testis reaches Primordial follicle, Descent Testis • Testis reaches iliac fossa in the 3rd month • They lie at the site of deep inguinal ring up to 7th month. • In 7th Month they pass through inguinal canal. • They reach scrotum by end of 8th month. Descent of Ovary • Ovary Descends from lumbar region. • Gubernaculum is formed which extends from ovary to labium majus. The part of gubernacu- lum persisting in between ovary and uterus becomes Round ligament of ovary. • The part of gubernaculum which lie in between uterus and labium majus becomes Round liga- ment of uterus. Dr. Parameswar S. Final Yr. P.G. Scholar Dept. of Rachana Shareera. “Shareera Ratna 2011” Award to Dr. Muralidhar N. prof. Sri Sri Ayurveda Medical College, Bangalore by International Association of Ayurveda Physicians 22
  25. 25. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 Embryological development of bladder, urethra, uterus and uterine tubes, prostate and external genitalia A . Development of blader ™™ Caodally, the Vesico - Urethra canal ™™ The primitive Uro- genital sinus divides forms the primitive urethra, and defini- into tive UGS divides into to Pelvic & Pjallic i Vesico - urethral canal parts. ii Definitive UGS i In females : Urethra is formed from - ™™ Urinary bladder is derived from the cranial part of Vestibulo-urethral canal * Primitive Urethra. (endoderm) * Part of pelvic part of UGS ™™ Internal feature - * Rest of the pelvic part forms * Region of trigone is formed vestibule. by bsorbed mesonephric ducts a ii In males : Urethra is formed - (mesoderm) * Prostatic urethra: Same as * Muscular Serous walls are de- that in females. rived from Splanchnopleuric * Membranous urethra : From mesoderm. pelic part of UGS. ™™ Initially, the bladder is continuous with * Penile urethra : From phallic allantois cranially. part of UGS. ™™ Later, allantois atrophies and forms a fi- * Terminal part of Penile urethra brous cord called Urachus. (in Glans) - Ectoderm. ™™ Urachus forms the median umbilical ligament connecting the apex of blad- C. Development of Prostate der to umbilicus. ™™ Secretory epithelium - Develops from the large number of buds arising from B. Development of Urethra Prosthetic urethra ™™ The primitive Uro- genital sins divides ™™ Inner glandular zone - From the buds into - arising from rest of the prosthetic ure- i Vesico - Urethral canal thra (endoderm). ii Definitive UGS ™™ The Mensonephric ducts, while being ™™ The Mesonephric ducts and Ureters absorbed moves closer to enter the open separately at the Junction of these prosthetic urethra which develops into two parts. ejaculatory ducts. ™™ In females, the buds give rise to Ure- thral & Para Urethral glands. 23
  26. 26. Apl-Sept. -2011/ Oct-March - 2011-12 Jnana Srotas Vol. 7 / 8, Issue-1-2/3-4 D. Development of Uterus & Uterine tubes c. Urogenital membrane breaks ™™ The Para - Mesonephric ducts, formed down to establish continuity by the invagination of coelomic epithe- with UGS and exterior. lium are continuous caudally (in mid d. Labia minora - Primitive Ure- line) forming the Utero- Vaginal canal. thral folds form labia minora * Caudla end of this is in close II In Male contact with the dorsal wall of a. Phallus - Genital tubercle be- definitive UGS. This part gives comes cylindrical to form phal- rise to vestibule in female. lus. This enlarges greatly to form ™™ Epithelium of Uterus -From fused part Penis and as it grows, coronary of Para Mesonephric ducts. sulcus develops & thus Glans ™™ Myometrium - From the surrounding becomes distinguishable. mesoderm. b. Prepuce - Form by reduplication ™™ Fundus of Uterus - As the thickness of of ectoderm covering Phallus. the myometrium increases, unfused c. Linear groove lined by ectoderm horizontal parts of para Mesonephric extends onto undersurface, ducts gets partially embedded to form and is called Primitive urethral the fundus of uterus. groove. ™™ Uterine tubes - Develop from unfused d. Endodermal cells in the phallic part of Para- Mensonephric duct. part proliferate and grow in to phallus forming a solid plate called the Urethral plate. These E. Development of Vagina are in contact with the ectoder- ™™ The lower end of the Utero-Vaginal Ca- mal cells lining the primitive nal, which comes in contact with UGS is urethral groove. separated by the formation of solid plate f. Margins of the definitive urethral called Vaginal plate. groove form definite urethral ™™ Vagina is formed by development of lu- folds. men within the plate. g. The folds fuse from UGS poste- riorly to phallus to form Penile F. Development of External genitalia urethra. I In Female: h. Genitalswellings fuse in midline a. Clitoris - Genital tubercel be- to form Scrotal sac. comes cylindrical to form Clito- ris. Dr. Remitha K.K. b. Labia majora- Genital swellings 3rd Yr. MD enlarge to form Labia majora. Dept. of Rachana Shareera. Fused posterior commissure. 24