Incidence and ossification of sesamoid bones in the hands and feet: a radiographic study in an Arab population

The incidence and ossification of sesamoid bones in the hands and feet were studied in 922 radiographs (400 hands and 522 feet) in an Arab population from Bahrain, 5-83 years of age and consisting of 549 adults (393 men and 156 women) and 373 children (286 boys and 97 girls). All radiographs of the hand and foot in the adult population showed two sesamoid bones in the thumb metacarpophalangeal (MCP) joint and in the hallucal metatarsophalangeal (MTP) joint, respectively. Only 2.3% and 1.5% of hands showed sesamoids at the MCP joints of the middle and ring fingers respectively compared to a reported incidence of 7.1% for each digit in Caucasians. The incidence of sesamoids in the MTP joints of third and fourth toes (0.6% each) and inferior to the hallucal interphalangeal joint (3.1%) is probably the lowest reported so far in the literature. In the hands, ossification commenced first in the thumb sesamoids, at the age of 10 years in females and 11 years in males and was completed by the age of 13 and 14 years, respectively. In the feet, ossification began first in the hallucal sesamoids at the age of 8 years in females and 9 years in males and was completed by the age of 10 years in both sexes. The incidence and ossification of sesamoids in the hands and feet in the Arab population from Bahrain seem to differ considerably from reports in other populations. The clinical significance of our findings is discussed.

The membranous layer of superficial fascia: evidence for its widespread distribution in the body

A discrete membranous layer, "stratum membranosum", in human subcutaneous tissue is classically described as confined to the lower anterior abdominal wall and perineum and referred to as Scarpa's and Colles' fasciae, respectively. Evidence for its existence elsewhere in the body is scanty and therefore the present study was undertaken. Dissection of six embalmed adult cadavers, along with ultrasound imaging on four living subjects, were carried out to determine the existence, topography, and thickness of the membranous layer of superficial fascia in different regions of the body. In all six cadavers, a continuous layer of fibrous membrane in the superficial fascia was found consistently in all the dissected regions of the body and was also confirmed by ultrasonography. The arrangement and thickness of this membranous layer varied according to body region, body surface, and gender. It was thicker in the lower than in the upper extremity, on the posterior than anterior aspect of the body, and in females than in males. The mean thickness of the membranous layer ranged from 39 to 189 mum, being thickest in the leg and thinnest over the dorsum of the hand. The membranous layer was observed to have two or even three components in regions such as the breast, back, thigh, and arm and was seen to split, forming special compartments around subcutaneous major veins of upper and lower extremities, with fibrous septa extending to attach to the vessel wall. Functionally, the membranous superficial fascia may play a role in the integrity of the skin and support for subcutaneous structures particularly veins, by ensuring their patency. Understanding the topographic anatomy of this fascial layer may help explain body-contour deformities and provide the anatomic basis for surgical correction.

The hamate facet of the lunate: a radiographic study in an Arab population from Bahrain

Based on the presence of a facet for the hamate two types of lunate bone have been described in the wrist; type I is without a facet for the hamate while type II bears a facet on the medial surface for articulation with the proximal pole of the hamate. Compared to type I lunates, type II lunates have been shown to have different kinematics, are more prone to clinically relevant degenerative changes in the hamato-lunate joint and may cause ulnar-sided wrist pain. The incidence of type II lunates seems to vary in different populations. Postero-anterior (PA) view of plain radiographs of the hand was studied in Arab subjects from Bahrain (n=381; 307 males and 74 females) to determine the incidence of type I and type II lunates. The mean age of the subjects was 31.1 years, the range being 18-80 years. In the population studied, only 148 (38.8%) of the 381 wrists showed type II lunate; 121 (31.7%) were found in males and 27 (7.1%) in females. There was no significant difference in the mean age of subjects with type I or type II lunates (P=0.16). There was no correlation between side and gender with the presence or absence of a hamate facet on the lunate. The incidence of type II lunate was much lower than reports in the literature of populations from the Western world, which could be attributed to a genetic variation in the Arab population in Bahrain. These data indicate that osteoarthritis of the hamate or lunate is less likely to be a cause of ulnar-sided wrist pain in Bahraini Arabs.

Ear lobe crease: incidence in a healthy Malay population

The incidence of ear lobe crease (ELC) was studied in 1576 healthy Malay subjects (566 males and 1010 females), randomly selected from the residents of Kota Bharu, Malaysia. ELC was present in 31.1% of males and in 3.6% of females; this difference in incidence between the two sexes is statistically significant (p > 0.05). In males the incidence of Type I crease was highest (10.1%) while that of Type III crease was lowest (2.3%). In females Type II crease showed the highest incidence (1.9%) and Type III the lowest. The incidence of bilateral presence of all three types of ELC showed an age-related increase in males. The ELC often starts unilaterally and later develops bilaterally and earlier in males than in females.

Normal values for total hand length, palm length and middle finger length in Malaysian newborns from 34-42 weeks of gestation

Early identification of a syndrome at birth is of paramount importance for genetic counselling and possible prevention. Often malformation of the hands and fingers are cardinal manifestations of recognizable syndromes. As there are no published standards for hand and finger size for Malay newborn infants, this study was undertaken to establish normal values for hand, middle finger and palmar lengths, and their indices. A cross-sectional study was done on 509 consecutive newborn Malay babies between 34 and 42 weeks of gestation. Measurements were made on the right hand according to the recommended guidelines of Bergsma & Feingold (1975). The mean values for the measurements did not differ significantly between boys and girls, or change with gestation. For the whole group the mean value for total hand length was 64.4 +/- 3.42 mm, middle finger length 37.1 +/- 2.91 mm, palmar length 27.4 +/- 2.15 mm, finger index 0.425 +/- 0.03 and palmar index 0.58 +/- 0.03. A comparison with published measurements for newborns of different racial origin shows significant differences for the total hand length, middle finger length and palm length from Indian and Jewish infants, but not from Japanese infants. The indices were similar in Malay, Indian, Jewish and Japanese newborn infants.

A comparison of interalar width and intercanine distance in Malay males and females

The interalar width of the nose and the intercanine distance were measured in 266 Malay subjects (111 males and 155 females) randomly selected from the students of the School of Medical Sciences. University Sains Malaysia in Kota Bharu, Malaysia. The mean interalar width of the nose in male subjects was 39.8 +/- 2.3 mm (range 34-45 mm) and in female subjects 36.2 mm +/- 2.2 mm (range 30-41 mm). There is a statistically significant difference (t = 12.9: p < 0.05) in the nasal width between male and female Malay subjects. This agrees with the findings of other similar studies that males have wider noses than females. The mean maxillary intercanine distance in male subjects was 36.7 = 2.6 mm (range 30-42 mm) and in female subjects 36.2 = 2.3 mm (range 30-42 mm). The anterior maxillary arch is significantly wider in Malay subjects compared to Chinese from Singapore (Keng 1986) as p < 0.05 and to Caucasians (Sawiris 1977) as p < 0.05. There is a significant correlation (r = 0.312; p < 0.05) between the nasal width and the intercanine distance in female subjects but not in male subjects.

Fourth branchial pouch cyst: an unusual cause of neonatal stridor

Fourth branchial pouch anomalies are extremely rare and only a few such cases showing sinuses and cystic masses have been reported in the literature. We describe a patient who presented on the third day of life with cystic neck swelling of fourth branchial pouch origin giving rise to respiratory obstruction and stridor. Despite repeated aspiration of the cystic mass to relieve respiratory obstruction, rapid recurrence of the mass continued to cause stridor and ultimately required surgical excision. The clinical, radiological, and histopathological findings of this unusual condition are discussed with a review of the literature.

Distribution of hair on the dorsum of the phalanges of the hand in a Chinese population from Malaysia

Hair distribution on the dorsum of phalanges of the hand was studied on 302 Chinese subjects (134 males and 168 females) randomly selected from the residents of Kota Bharu, Malaysia. Proximal phalangeal hair was seen on the dorsum of both hands in 99.3% of male subjects but in only 85.1% of female subjects. Chinese females showed a significantly lower (p < 0.05) incidence of proximal phalangeal hair on the hands than Chinese males. Comparison with other racial groups showed that Chinese females had significantly less (p < 0.05) hair on the proximal phalanges of the hands than Malay and African (Nigerian) females. The least common digital combination of proximal phalangeal hair in female subjects was the presence of proximal phalangeal hair only on the fourth digit (ring finger) and was noted in 0.6% of subjects. This has not been reported before. The frequency of middle phalangeal hair (MPH) distribution in Chinese falls between that in Malays and in Japanese which is probably explained by the fact that all these three racial groups originate from Asia. A study of digital combination of MPH in Chinese showed that the most common and the least common combinations in the Chinese differ considerably from those in other races. A total of 16 patterns of hair distribution was noted on the dorsum of the phalanges of the hands in Chinese subjects. Our study showed that though Chinese females had less digital hair on the hands than Chinese males, they showed a much larger variety of patterns of digital hair distribution than males.

Variations in the formation of the cardiac plexus--a study in human foetuses

The origin and distribution of nerves forming the cardiac plexus and the subdivision of this plexus were studied in six human foetuses (2 male, 4 female) of gestational ages 30 to 40 weeks. The cardiac plexus was not divided into superficial and deep parts in any foetus. True plexiform arrangement of nerves forming the cardiac plexus was seen only after the nerves reached the walls of the heart. The sympathetic trunks, vagi, recurrent laryngeal nerves and phrenic nerves of both sides contributed to the cardiac plexus. The cervical sympathetic trunk showed only two ganglia bilaterally in one foetus; this has not been reported before. In one foetus on the right side, the middle cervical sympathetic cardiac branch joined the recurrent laryngeal and the phrenic nerves which has not been reported earlier. The sympathetic pathways to the heart were found to be very variable; no two foetuses showed the same arrangement. Awareness of these variations in the nerves forming the cardiac plexus would enhance the success of sympathectomy to augment cardiac blood flow or to relieve the severity of cardiac pain.

Five anthroposcopic traits of the ear in a Malaysian population

Five anthroposcopic traits concerning the ear, namely ear lobe attachment, position of ears, shape of the helix, presence of Darwin's tubercle and hairy ears have been studied in a Malay population from Malaysia. The results of the present study are compared with similar reports in other ethnic groups.

Upper eyelid and eyebrow dimensions in Malays

The upper eyelid crease height pretarsal skin and eyebrow height were studied in 305 Malay subjects (146 males and 159 females) varying in age from 2-80 years, who were randomly selected from the residents of Kota Bharu, Kelantan. In females, from the age of 11 years the mean pretarsal skin height increased progressively with age. In males, however, it decreased with age up to 60 years. In both sexes, subjects more than 60 years old showed highest values for pretarsal skin height. The mean eyelid crease height increased progressively with age from 11 years onwards in males but not in females. The mean eyebrow height increased with age in females but not in males. Eyebrow and eyelid measurements seem to show a definite racial variation. Besides establishing normal values for eyelid and eyebrow measurements in Malays, our findings indicate that age and sex should be taken into consideration to achieve satisfactory results in cosmetic eyelid surgery in Malays.

Incidence, density and direction of hair on the dorsum of phalanges of the hands in Malays

In this study 200 Malay subjects (100 males and 100 females) were randomly selected from patients attending outpatient clinics of Hospital USM, Kelantan, Malaysia, to find out the incidence, density and direction of hair on the dorsum of phalanges of the hand. These features have not been studied so far in females nor has such a study been conducted in Malays. The probability of density of hair distribution among the digits of both hands showed significant correlation on proximal phalanges (p < 0.05) in both sexes. Significant correlation was not observed, however, in the middle phalangeal hair (MPH) of the hands. The direction of proximal phalangeal hair, from little finger to the thumb, showed significant changes from ulnar to radial in both sexes (p < 0.05). Identification of isolated digits, which is of medicolegal importance, would be more accurate if the direction and the density of hair on the digits are both considered together. MPH was present in 48% of males and in 33% of females studied. Comparisons with presence of MPH in other populations show that Malays are ethnically similar to other Asiatic populations.

Dermatoglyphic patterns in schizophrenic patients

Schizophrenics (n = 250) and normal controls (n = 90) were studied to investigate and compare their dermatoglyphic patterns. Their fingerprint patterns were studied. The frequency of arches in the patient and control groups was similar. The frequency of loops in the control group was higher than in the patient group, and the trend was consistent in all the digits. The whorls in the patient group showed an increase over the control group in all the digits, although this finding was not statistically significant.

Schizophrenia associated with Klippel-Feil syndrome and flat foot

A 20 year-old patient presented with schizophrenia which was associated with Klippel-Feil syndrome and flat foot.

Hair distribution on the phalanges of the hands in Malays

618 Malay subjects were selected randomly to find out the frequency and patterns of hair distribution on the phalanges of their hands. Hair on the proximal phalanx was absent in 2% of the males and in 3.3% of the females. The middle phalangeal hair (MPH) was absent in 78% of the females and in 64.9% of the males. The frequency in order of MPH was found to be 4 > 3 > 5 > 2. Fifteen patterns of hair distribution on the phalanges of the hand were found. Such a large number of patterns has not been reported yet. No subject had hair on the distal phalanges. These observations when compared with earlier studies show that the Malays are similar to other Asiatic populations such as the Japanese and Nepalis.

Patterns of superficial veins of the cubital fossa in Malays

Patterns of superficial veins of the cubital fossa were studied in 170 male and 96 female Malays. Six venous patterns were observed. The less commonly known but clinically important patterns observed included absence of communication between basilic and cephalic veins (in 7.3% females and 8.8% males); an arched median cubital vein (in 2.0% females and 6.5% males); absence of the cephalic vein (in 1.0% females and 2.9% males) and two median cubital veins (in 1 male only). Awareness of these uncommon cubital venous patterns and their approximate incidence would be very useful for those performing venepuncture or venesection in Malays, especially under emergency conditions.

Eccrine cylindroma of the ear canal--report of a case

Eccrine cylindroma is a benign tumour arising from sweat glands in the skin. It favours the face, forehead and scalp involving the turban area and hence is called a turban tumour. Amongst a variety of tumours originating from adnexal skin structures, which may appear in the ear canal, eccrine cylindroma forms a very rare entity. We present such a case and discuss its pathological and clinical features.

Religious psychotherapy in anxiety disorder patients

Religious patients with generalized anxiety disorder were given religious psychotherapy in addition to supportive psychotherapy anxiolytic drugs. Those receiving religious psychotherapy showed significantly more rapid improvement in anxiety symptoms than those who received supportive psychotherapy and drugs only. Thus, religious patients may require a different form of psychotherapy.

An anomalous muscle in the distal half of the arm

During dissection an anomalous muscle was found on the medial aspect in the distal half of one left upper extremity. This muscle arose from the humerus between the m. coracobrachialis and the m. brachialis, passed obliquely across the front of the brachial artery and median nerve and blended with the common origin of the forearm flexor muscles. It does not appear to be an additional head of the biceps brachii or the brachialis muscles. The existence of this anomalous muscle should be kept in mind in a patient presenting with a high median nerve palsy together with symptoms of brachial artery compression.