October, 2012 | Master Of Medicine

Monthly Archives: October 2012

Ondine’s curse and primary alveolar hypoventilation

Ondine’s curse maybe a familiar phrase to you, after going through the respiratory system topics.When I came across this story in my PG entrance book, I wanted to know more about Goddess Ondine and Ondine’s curse.

Ondine (ballet)

Ondine (ballet) (Photo credit: Wikipedia)

Ondine was a water goddess, a nymph in French foklore written by Friedrich de la Motte Fouqué. Nymphs are immortals.If a nymph falls in love with a man and bears his child,she will become mortal and age like a mortal woman, thus losing her eternal youthfullness and beauty.

When Ondine saw the handsome young Palemon she was smitten and began to watch for him on his daily walks. When Palemon noticed her, he was taken by her incredible beauty and came back frequently to try to get a glimpse of her again.

Eventually they talked and fell in love. He broke his engagement with the young noblewoman Berta and, in time, convinced Ondine to marry him. When they exchanged their wedding oaths, Palemon vowed that “My every waking breath shall be my pledge of love and faithfulness to you.”



But it was not to be.


The following year Ondine gave birth to their son. From that moment on, her beauty began to fade, her body suddenly susceptible to the effects of age. As her youthful attractiveness gave way to a more mature beauty, Palemon’s eye began to wander to the younger women he met at court.


One fateful day Ondine was out walking on their estate when she heard the sound of Palemon’s familiar snoring. Planning to take him back home so he could finish his nap, the amused Ondine entered the stables to wake him.


The scene she encountered filled her with great sorrow. Discarded garments littered the floor and her beloved Palemon lay sleeping in the haystack, his arms wrapped around his former fiance Berta. Having sacrificed her immortality for this man, she was filled with anger and regret.


Kicking her sleeping husband, she woke him and uttered her curse. “You pledged faithfulness to me with your every waking breath and I accepted that pledge. So be it. For as long as you are awake, you shall breathe. But should you ever fall into sleep, that breath will desert you.”And so it was.

Palemon would never sleep again.Primary alveolar hypoventilation is another name for Ondine’s curse.

In mammals, rhythmic respiratory activity is generated in the pre-Bötzinger complex, which is formed by a network of six physiologically different neuronal populations Selective lesioning of this neuronal network causes rhythmic respiratory activity to cease,resulting in apneustic breathing also known as curse of Ondine or just as Ondine’s curse.

Mannings score and Bishops score

The three most important scores in Obtetrics are Mannings score,Bishops score and APGAR score.

Mannings score/Biophysical Profile(BPP)

The components of Biophysical profile are:

  1. Non Stress Test(NST)
  2. Amniotic Fluid Index
  3. Foetal breathing movements
  4. Foetal gross body movement
  5. Fetal tone

Modified BPP/Vintzileos scoring test

  1. Non Stress Test
  2. Amniotic Fluid Index

Bishops Score

The Bishop score grades patients who would be most likely to achieve a successful induction. The duration of labor is inversely correlated with the Bishop score; a score that exceeds 8 describes the patient most likely to achieve a successful vaginal birth. Bishop scores of less than 6 usually require that a cervical ripening method be used before other methods.

Each components is given a score of 0-2 or 0-3. The highest possible score is 13.

Ventricles in the brain

What is a ventricle in the brain?

The ventricles of the brain are a communicating network of cavities filled with cerebrospinal fluid (CSF) and located within the brain parenchyma.

Which are the ventricles?

The ventricular system is composed of 2 lateral ventricles, the third ventricle, the cerebral aqueduct, and the fourth ventricle . The choroid plexuses located in the ventricles produce CSF, which fills the ventricles and subarachnoid space, following a cycle of constant production and reabsorption

 Where is the location of the ventricles?

  • 2 Lateral Ventricle- Lies in the cerebral cortex
  • 3rd ventricle-Lies between the two thalami
  • 4th Ventricle-Lies on the brain stem between medulla and cerebellum

Lymphnode levels of neck

The neck is divided into 6 areas called Levels. The levels are identified by Roman numeral, increasing towards the chest.

  • Level I: Submental and submandibular nodes
    • Level Ia: Submental triangle
    • Level Ib: Submandibular triangle
  • Level II: Upper jugular nodes
  • Level III: Middle jugular nodes
  • Level IV: Lower jugular nodes
  • Level V: Posterior triangle group
  • Level VI: Anterior triangle group
  • Level VII: Upper mediastinal nodes.

Level VII to denote lymph node groups in the superior mediastinum is no longer used.Lymph nodes in  non-neck regions are known by the name of their specific nodal groups.

  • Level I: Submental and submandibular triangles.
    Ia is submental triangle bound by the anterior bellies of the digastric and the mylohyoid.
  •  Ib is the triangle formed by the anterior and posterior bellies of the digastric and body of mandible.

Level II, III, IV: nodes associated with the IJV; fibroadipose tissue located medial to the posterior border of SCM and lateral to the border of the sternohyoid.

  • Level II: upper third including the upper jugular and jugulodigastric nodes and the upper posterior cervical nodes.Bound by the digastric muscle superiorly and the hyoid bone (clinical landmark), or the carotid bifurcation (surgical landmark) inferiorly.
  •  IIa contains nodes in the region anterior to the spinal accessory nerve and IIb posterior to the nerve.
  • Level III: middle third jugular nodes extending from the carotid bifurcation superiorly to the cricothyroid notch (clinical landmark), or inferior edge of cricoid cartilage (radiological landmark), or omohyoid muscle (surgical landmark).
  • Level IV: lower jugular nodes extending from the omohyoid muscle superiorly to the clavicle inferiorly.
  • Level V: posterior triangle group of lymph nodes located along the lower half of the spinal accessory nerve and the transverse cervical artery. The supraclavicular nodes are also included in this group. Bounded by anterior border of the trapezius muscle,posterior border of the sternocleidomastoid muscle, and the clavicle.
  •  Level VI: anterior compartment group comprises lymph nodes extending from the level of the hyoid bone superiorly to the suprasternal notch inferiorly. Located within this compartment are the perithyroidal lymph nodes, paratracheal lymph nodes, lymph nodes along the recurrent laryngeal nerves, and precricoid lymph nodes

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