ABSTRACT. We report the first case of extensive involvement of isolated intracranial Rosai-Dorfman's disease (RDD) in a child. Our case is unique because it presents with involvement of the middle cranial fossa, cavernous sinus, pituitary gland, orbit, ethmoid and sphenoid sinuses. Previous cases of intracranial RDD in children have reported separate involvement of cavernous sinus, suprasellar region, and frontal and petroclival regions. Involvement of the pituitary gland has so far not been reported. A 14-year-old male presented with a medical history of loss of vision, raised erythrocyte sedimentation rate (ESR), and abnormal prolactin and cortisol levels. Radiologically the diagnosis was meningioma. The histopathological diagnosis was RDD with emperipolesis and S-100 positivity. RDD is a histiocytic proliferation of unknown aetiology, which commonly affects lymph nodes. Uncommonly it involves the extranodal sites and rarely the central nervous system (CNS). 80 cases of RDD involving CNS have been reported in the literature, and only 5 were in children. Although the definitive diagnosis of RDD disease is based on the histopathology report, it should be included in the differentials of a lesion mimicking meningioma especially in children.

Abstract:During routine dissection of an adult male cadaver in the Department of Anatomy It was found that the right median nerve was formed by three roots, two coming from lateral cord and one from medial cord of brachial plexus.The uppermost or highest root was noted to be at the level of origin of coracobrachialis muscle. The second root was found to be immediately below the first one.These two roots were found to be passing obliquely in front of second and third part of axillary artery and joining individually with the medial root of median nerve and forming median nerve trunk, in front of third part of axillary artery. (Figure No.-1) Further distribution of the anomalous median nerve in the arm, forearm and palm was normal. The arterial pattern in arm was also normal. The left median nerve was also normal. Discussion:The median nerve is normally formed by the union of two roots: lateral root of median nerve coming from the lateral cord (C5, C6, C7) of brachial plexus and medial root of median nerve coming from the medial cord (C8, T1) of brachial plexus. The two roots embrace the third part of the axillary artery, uniting anterior or lateral to it. Some fibres from C7 often leave the lateral root in the lower part of the axilla passing

The coracobrachialis muscle in the arm is morphologically the sole representative of adductor group muscle in the arm, but such function during the process of evolution became insignificant in man. It is more important morphologically than functionally. Variant insertion of the coracobrachialis muscle was found during routine dissection of an adult male cadaver in the Department of Anatomy, College of Medical Sciences, and Bharatpur, Nepal.Normally the coracobrachialis muscle is inserted into the middle of the medial border of the humerus. In the present case an additional slender tendon passed inferiorly, crossing anterior to the median nerve and brachial artery, before attaching to the medial epicondyle of the humerus. Most of the proximal part of the tendon gave rise to an aponeurotic expansion that inserted into the distal medial border of the humerus. The tendinous insertion and aponeurotic expansion may represent a variant of the coracobrachialis longus (Wood's) muscle and the internal brachial ligament or the ligament of Struthers. The ulnar nerve was found to be traversing below the aponeurotic expansion. This type of anomalous insertion of coracobrachialis muscle may lead to compression of median nerve, brachial artery and ulnar nerve.

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The variations in origin of renal arteries are very common. During routine dissection of a male cadaver we found left accessory renal artery. The origin of accessory renal artery is immediately below main renal artery. The left inferior accessory renal arteries run towards inferior pole of left kidney, in the area where the left renal vein was leaving the left kidney. The vascular variations are very important for vascular surgeons, urologists, nephrologists, radiologists.

Anemia is a common medical disorder affecting a lot of women in pregnancy in the developing countries. Daily oral iron supplementation during pregnancy reduces the prevalence of anemia. In the present study we have compared the hematological responses to oral iron therapy using the formulation of iron poly maltose complex in anemic and normal pregnant women. The haemoglobin (Hb) level and other blood parameters were studied in anemic and non-anemic pregnant women both before and after oral iron therapy. Hemoglobin, iron indicators improved significantly with oral iron therapy and appear to have good compliance and efficacy. This helps us to assess the varied comparative responses in both the categories. The study will be indicative about the rational use of iron in iron deficiency anemia. Key words: Anemia; blood; hemoglobin; deficiency. DOI: 10.3126/jcmsn.v6i3.4067Journal of College of Medical Sciences-Nepal, 2010, Vol. 6, No. 3 pp.1-7

Brachial plexus is the plexus of nerves, that supplies the upper limb.Variations in the branches of brachial plexus are common but variations in the roots and trunks are very rare. Here, we report one of the such rare variations in the formations of the lower trunk of the brachial plexus in the right upper limb of a male cadaver. In the present case the lower trunk was formed by the union of ventral rami of C7,C8 and T1 nerve roots. The middle trunk was absent. Upper trunk formation was normal. Journal of College of Medical Sciences-Nepal,2011,Vol-6,No-4, 49-52 DOI: http://dx.doi.org/10.3126/jcmsn.v6i4.6727

The present study was undertaken to compare plasma-pleural effusion albumin gradient with Light's traditional criteria for differentiating exudates from transudate in pleural effusion who were undergoing diagnostic and therapeutic thoracocentesis in whom the etiology of effusion could be determined were studied. Blood and pleural fluid chemistries were measured to determine plasma-pleural effusion albumin gradient and Light's criteria parameters like pleural fluid proteins, fluid to plasma protein ratio, fluid LDH and fluid to serum LDH ratio and we observed some misclassifications in exudates and transudates. Using an albumin gradient of 1.2 gm/dl or less to indicate exudate and >1.2 gm/dl to indicate transudate, none of the transudates were found to be is misclassifical, but 1 case of exudate (malignant pleural effusion) was misclassifical. We conclude that although Light's criteria for exudates are very sensitive, albumin gradient of 1.2 gm/dl or less tends to be more specific to exudates.