DocumentsDate added
Research article
Nisha Bindu Murali *, Murugadoss, R.Vidhya, S.Karthik, Sateesh
Affiliation:-
Department of Anaesthesia, Chennai Medical College and Research Center,IRUNGALUR, TRICHY-621105 Tamilnadu,India
The name of the department(s) and institution(s) to which the work should be attributed:
Chennai Medical College Hospital and Research Centre, Irungalur, Trichy-621105 Tamilnadu, India
*To whom it corresponds:-
Dr.Nisha Bindu Mural.
Senior resident,
Chennai Medical College Hospital and Research Centre, Irungalur, Trichy-621105 Tamilnadu, India
Core idea: The main purpose of this study was to find the effect of systemic hypertension in blood-brain-barrier and indirectly csf-albumin levels. And its contribution as a predictor of Stroke in the future which mostly occurs due to disruption of BBB .
Abstract:
Aim: To compare the Cerebrospinal fluid Albumin levels in normal patients and patients with systemic hypertension and hence to analyse the effect of systemic hypertension in the blood-brain-barrier. Materials and methods: The study was conducted in Chennai Medical College Hospital and Research Center, Irungalur, Trichy from May to June 2013. Hospital ethical committee approval was attained and informed written consent was also obtained from all patients participating in the study. All patients fulfilling inclusion and exclusion criteria were included in the study. Both hypertensive and normal patients undergoing sub-umbilical surgeries under subarachnoid block were included in the study after obtaining informed consent. 49 patients in each group, Group A included patients with systemic hypertension on treatment and Group B were normal patients without any co-morbid conditions. Under strict aseptic precautions lumbar puncture was done using 25 G Quincky needle and 0.5ml of CSF was collected in a sterile container and send for biochemical analysis. Patients who had traumatic tap were excluded from the study. CSF -albumin levels were calculated by immunodensitometric method and then were statistically analyzed using Chi-square test and Students–t Test.
Results: Demographic data was analyzed using Chi-Square test and found that there was not any statistical significance. While, CSF albumin levels in normal group was 137.25 ± 28.77 while it was 289.41 ± 54.05 in hypertensive group .This difference was statistically significant.
Discussion: The albumin in the blood reaches CSF through the process of diffusion1. This restricted exchange of materials between blood and perivascular and extravascular fluid is done through the blood-brain barrier in the central nervous system. Disruption of tight junctions in the BBB is the hallmark of not only many CNS pathology but also systemic diseases7. One such diseases is systemic hypertension which brings about inflammatory changes in the body including neuro-inflammation. This not only causes disruption of BBB but also increases the Para cellular permeability i.e. bends without breaking them.
This cellular change in the BBB due to hypertension may increase its permeability to albumin which in turn increases the CSF albumin levels. In our study, CSF albumin level was higher in hypertensive group compared to normal patients. This difference was statistically significant. This difference signifies the changes occurring in the BBB in hypertensive individuals which could lead to stroke in the future. Weather CSF albumin levels could be used as a predictor of stroke and its relation to years of hypertensive state are to be analyzed in our next study.
Key words: CSF Albumin levels; Blood-Brain-Barrier (BBB); Diffusion.
REFERENCES
1.W. A. Bonadio, L. Stanco, R. Bruce, D. Barry, and D. Smith,“Reference values of normal cerebrospinal Fuid composition in infants ages 0 to 8 weeks,”Pediatric Infectious Disease Journal 1992;11(7):589–591, .
2.C. E. Johanson, J. A. Duncan, P. M. Klinge, T. Brinker, E. G.Stopa, and G. D. Silverberg, “Multiplicity of cerebrospinal fluid functions: new challenges in health and disease,” Cerebrospinal Fluid Research 2008;(5): 10.
3.E. M. Carmona-Calero, H. Perez-Gonzalez, I. Martinez-Pena y Valenzuela et al., “Effect of the arterial hypertension and captopril treatment on the angiotensin II content in the subfornical organ. A study in SHR rats,” Histology and Histopathology.2005: 20(1): 135–138.
4.E. M. Carmona-Calero, I. Gonzalez-Marrero, M. Castaneyra-Martin et al., “Hypertension effects on p73 expression in the rat circumventricular organs and cerebrospinal fluid,” World Journal of Neuroscience, 2012; 2(2);68–73.
5.I. Gonzalez-Marrero, E. M. Carmona-Calero, P. Fernandez-Rodriguez et al., “Expression of certain proteins in the subfornical organ and cerebrospinal fluid of spontaneously hypertensive rats,” Histology and Histopathology.2007; 22(12):1371–1378.
6.M. R. Del Bigio, “Hydrocephalus-induced changes in the composition of cerebrospinal fluid,” Neurosurgery. 1989;25(3):416–423.
7.H. Al-Sarraf, F. Ghaaedi, and Z. Redzic, “Time course of hyperosmolar opening of the blood-brain and blood-CSF barriers in spontaneously hypertensive rats,” Journal of Vascular Research,vol. 2007;44(2): 99–109.
8.Habgood MD, Sedgwick JE, Dziegielewska KM, Saunders NR A developmentally regulated blood-cerebrospinal fluid transfer mechanism for albumin in immature rats. J Physiol.1992; Oct 456:181-92.
9.Ibrahim Gonzalez-Marrero,Leandro Castaneyra-Ruiz ,Juan M. GonzalezToledo, “ High Blood Pressure Effects on the Blood to Cerebrospinal Fluid Barrier and Cerebrospinal Fluid Protein Composition:A Two-Dimensional Electrophoresis Study in Spontaneously Hypertensive Rats” International Journal of Hypertension, Volume 2013 (2013), Article ID 164653,2013.
10.I. Gonzalez-Marrero, L. Castaneyra-Ruiz, J. M. Gonzalez-Toledo et al., “High blood pressure effects on the brain barriers and choroid plexus secretion,” Neuroscience & Medicine.2012;3(1);60–64.
11.Huber JD, Egleton RD, Davis TP Molecular physiology and pathophysiology of tight junctions in the blood-brain barrier. Trends Neurosci . 2001; 24(12):719-25.
12.D. Carnevale, G. Mascio, M. A. Ajmone-Cat et al., “Role of neuroinflammation in hypertension-induced brain amyloid pathology,” Neurobiology of Aging. 2012;33(1):205.e19–205.e29.
13.I. Gonzalez-Marrero, L. Castaneyra-Ruiz, J. M. Gonzalez-Toledo et al., “High blood pressure effects on the brain barriers and choroid plexus secretion,” Neuroscience & Medicine. 2012; 3(1):60–64.
Article citation:
Nisha Bindu Murali, Murugadoss, R.Vidhya, S.Karthik, Sateesh. A comparative study of the cerebrospinal fluid -albumin levels in normal patients and in patients with systemic hypertension. J Pharm Biomed Sci 2014; 04(02): 118-121. Available at www.jpbms.info.
Source of support: None
Competing interest / Conflict of interest
The author(s) have no competing interests for financial support, publication of this research, patents and royalties through this collaborative research. All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript.
Copyright © 2014 Nisha Bindu Murali, Murugadoss, R.Vidhya, S.Karthik, Sateesh . This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Case report
Srivastava Monika1,*,Abhijeet Yadav1,Baweja Sonia2,Sharma Vandana3,Dixit Asha4
Affiliation:-
1M.B.B.S,Post Graduate Student, Department of Anatomy, Gandhi Medical College, Bhopal (MP),India
2MS,Assistant Professor,3MS, Associate Professor,4MS, Professor & Head, Department of Anatomy, Gandhi Medical College, Bhopal (MP),India
The name of the department(s) and institution(s) to which the work should be attributed:
Department of Anatomy,
Gandhi Medical College, Bhopal (MP), India
*Corresponding author:-
Dr. Monika Srivastava.
C/o Mr. R.K Srivastava
H.No 1532, Near Ebnezer School,
Bhagat Singh Nagar, Bhind Road
Gola Ka Mandir, Gwalior (MP)-474005,India
Contact No: 09893553306, 09027156756
Abstract:
Background: Sternalis is a mysterious strap like muscle present in approx. 3-4% of population. Its awareness among surgeons & radiologist is imperative as it may lead to misdiagnosis and have huge clinical implications.
Aim: To study anatomical & morphological characteristics of the study muscle.
Material & Methods:- A formalin preserved male cadaver was incised in the mid sternal line. Bilateral strap muscles were seen in the parasternal region. The area was cleaned and properly visualized. Subsequently, it was measured and photographed with proper labels.
Result: Muscles were present on the anterior wall of the thorax. Both had an aponeurotic origin. The tendon of the left side was intermingled with Sternoclediomastiod while the right one was intermingled with the muscles fibers of the Pectoralis Major of both the side. Neurovascular supplies of both the side were from the intercostals nerves and vessels.
Conclusion: Dissected muscles were Sternalis Muscles. They were straight muscles that were present in the parasternal area with separate origins and insertions with no boney attachment as a Panniculous Carnosus muscle
Keywords: Sternalis; Panniculous Carnosus; Bilateral Strap Muscles.
Srivastava Monika,Abhijeet Yadav,Baweja Sonia,Sharma Vandana,Dixit Asha. A Case report on bilateral rectus sternalis muscles: A mysterious muscles. J Pharm Biomed Sci 2014; 04(02): 80-83. Available at www.jpbms.info.
REFERENCES
1.Kulkarni DU, Kulkarni UK. The unilateral rectus sternalis muscle- a case report. AL Ameen J Med Sci.2010;3(2):169-71.
2.Bailey PM, Tzarnas CD. The Sternalis muscle: a normal finding encountered during breast surgeries. Plast Reconstr Srug,1999;103(4):1189-90.
3.Thute P, Bobde H, Gajbe U, Sthapak E, Bharti S, Chaulwar M, Bakane B. The Bilateral Sternalis: An uncommon anatomical variant. Journal of Clinical and Diagnostic Research, 2012;6(5)767-769.
4.Young LB, Young BJ. The sternalis muscles: its incidence and imaging finding on MDCT. J Thoracic Imaging, 2006;21: 179-83.
5.Mishra BD. The sternalis muscle. J Anat Soc India,1954;3:47-48
6.Shah AC. The sternalis muscle. Indian J Med Sci, 1968;22:46-47.
7.Arraez ALA, Sobrado PJ, Merida VJR. The left musculus sternalis. Clin Anat, 2003;16(4): 350-54.
8.Turner W. On the musculus sternalis. J Anat Physiol, 1867;1: 246-253.
9.Clemente CD. Muscle and fasciae. Gray’s Anatomy, 30th American edn, Philadelphia: Lea and Febiger. 1985:520.
10.Sadler TW. Muscular system. Langman’s Medical Embrology, 7th edn, Baltimore: Williams and Wilkins. 1995;185.
11.Barlow RN. The sternalis muscle in American white and Nergroes. Anatomical Record, 1934;61: 413-26.
12.Jelev L, Georgiev G, Surchev L. The sternalis muscle in the Bulgarian population: Classification of the sternaales. J Anat 2001;199: 359-63.
13.Jeng H, Su SJ. The sternalis muscle: an uncommon anatomical variant among Taiwanese. J Anat. 1998;193:287-288.
14.Pereira BDV, Tavares AS. Sobre um caso de coexistencisa do mUsculo pre-esternal e de arco axilar muscular. Clinca Contemporanea. 1946 ;9 : 526-28.
15.Glasser SP. Electrocardiogram of the month. J Louisiana State M Soc. 1975;127: 136-50.
16.Bardley FM, Hoover HC, Hulka CA, Whitman GJ, McCarthy KA, Hall DA, et al. The sternalis muscle: an unusual normal finding seen on mammography. Am J Roentgen. 1996;166: 336-36.
17.Schulman MR, Chun JK. The conjoined sternalis- pectoralis muscle flap in intermediate tissue expander reconstruction after mastectomy. Ann Plast Surg. 2005;55(6):672-75.
18.O’Neil MN, Folan CJ. A case report: the bilateral sternalis muscle with a bilateral pectoralis major anomaly. J Anat. 1998; 193: 289-92.
Competing interest / Conflict of interest
The author(s) have no competing interests for financial support, publication of this research, patents and royalties through this collaborative research. All authors were equally involved in discussed research work. There is no financial conflict with the subject matter discussed in the manuscript.
Source of support: None
Copyright © 2014 Srivastava Monika,Abhijeet Yadav,Baweja Sonia,Sharma Vandana,Dixit Asha. This is an open access article distributed under the Creative Commons Attribution. a