Anatomical Observation of Different Shapes of Foramen Magnum and Its Clinical Implications: A Study in Dry Adult Human Skulls of Indian Population

Background: Understanding of thoroughly explained anatomical basis is must for various surgical approaches at the craniovertebral junction. High mortality and morbidity are anticipated during the surgical procedures when undertaken without in depth anatomical knowledge. With so much clinical importance in this area, our study will present a thorough understanding in terms of skull. Objectives: The aim of the present study is to evaluate the various shapes of foramen magnum in dry adult human skulls of Indian population and to find out their clinical correlation. Materials and methods: 347 dried adult human skull base obtained from the Department of Anatomy, Geetanjali Medical College and Hospital, Udaipur, Rajasthan and other medical colleges were used in the present study. All the dry adult human skulls were observed from outer side at their base by naked eyes to determine the shape of foramen magnum. It was classified into one of the following shapes: - Oval, round, tetragonal, egg shaped, hexagonal, pentagonal and irregular. Results: The shape of the foramen magnum in dry skulls were oval in 44.95%, round in 30.84%, hexagonal in 9.23%, irregular in 6.63%, pentagonal in 5.19%, tetragonal in 1.73 %, and egg shaped in 1.44%. Conclusion: Inferences of the present study in the form of variations in the shapes of foramen magnum will be useful to the neurosurgeons, radiologists, orthopedics, anthropologists, forensic experts as well as anatomists. Further these data can be used as an anatomical reference for the researchers.

Prevalence of ocular morbidities among school children in Raipur district, India

Purpose: To estimate the prevalence of various ocular morbidities in school children (5–15 years) utilizing a comprehensive mobile eye unit in Central India. Methods: A prospective, cross-sectional, school-based observational study was carried out in Raipur, Chhattisgarh, India between December 2017 and September 2018. A total of 1557 eligible school-going children in the age group 5–15 years were evaluated. Random sampling was done to allocate schools (n = 29) and children from various urban and rural (836 vs 721) schools. The primary objective was to estimate the prevalence of ocular morbidities in school-going children in Raipur district, India. The secondary objective was to analyze whether geographical location (rural vs urban), age group, and gender led to any differences in ocular morbidity patterns. Results: The mean age of the study population was 10.3 ± 2.4 years. There were 691 (44.4%) boys and 866 (55.6%) girls. Ocular morbidity was present in a total of 331 (21.2%) children. Vitamin A deficiency was the most common cause of ocular morbidity, noted in 156 (10%) children, followed by refractive error (81, 5.2%). Myopia was significantly higher in urban school children (4.3%) compared to rural children (1.9%) (P = 0.002). The older age group had a higher prevalence (7.6%) of refractive error, especially myopia, compared to the younger age group (2.2%) (P < 0.001). Conclusion: Vitamin A deficiency prevalence was much higher indicating missed opportunities for vitamin A supplementation at a younger age. Refractive error was more prevalent in the urban population as well in the older age group (11–15 years), indicating a need for frequent eye screening.

Awareness and utilization of Geriatric Welfare Schemes among urban elderly population of District Gautam Budh Nagar

Background: India has 8.6% elderly population which is going to increase to 12% by 2025. Government of India is providing for the elderly through various social security and welfare schemes as well as legislations. But various studies, mostly in rural areas have shown that the awareness regarding these schemes was poor and incomplete. Utilization of schemes by the beneficiaries was even poorer. Very few studies have assessed the same in urban areas. Aims & Objectives: To assess the awareness and utilization of geriatric welfare schemes and factors associated with them among urban elderly. Material & Methods: The study was conducted in urban field practice area of Dept of Community Medicine, SMS&R, Greater Noida. 402 elderly living in slums of Bhangel, Noida, were interviewed using semi structured questionnaire assuming 50% awareness levels in the urban area with 10% relative precision and 95% confidence interval. Results: Awareness regarding any one scheme was 31.6%, of whom only one fourth subjects knew about more than one scheme. Among those who knew about the schemes, only 40% were utilizing them. The awareness as well as utilization was found to be significantly associated with religion, caste and educational status of the subject. Conclusion: The study shows poor awareness and even poorer utilization of geriatric welfare schemes among elderly people of urban slums. Further studies are required for judging the influencing factors.

Fulminant scleral abscess secondary to infected scleral buckle with Moraxella species

We here report a case of scleral buckle infection with fulminant scleral abscess secondary to Moraxella species. A 54-year-old chronic alcoholic male with a history of retinal detachment repair, with scleral buckle 8 years prior, presented with complaints of severe pain, redness, and swelling in the right eye since 2 weeks. The patient was diagnosed with scleral buckle infection, the buckle was removed, and cultures revealed Moraxella species. The postoperative course included fulminant scleral abscess treated with dual antibiotic therapy that included ceftriaxone and moxifloxacin. All systemic antibiotics were discontinued after 3 weeks, retina remained attached, and no recurrence occurred over a 1-year follow-up. Moraxella, though commonly associated with bacterial keratitis, can also lead to buckle infection, especially in chronic alcoholic and immunocompromised patients. In buckle infection, infected buckle along with sutures should be immediately removed without damaging underlying compromised sclera. Lastly, culture and drug sensitivity play a very important role in buckle infections.

Successful treatment of aggressive posterior retinopathy of prematurity with diode laser in ocular albinism: A case report

Oculocutaneous albinism is characterized by partial or complete absence of melanin in retinal pigment epithelium (RPE) and uveal melanocytes. Absence of typical fundal background from RPE and choroid makes it difficult to diagnose retinal disorders in ocular albinism. Lack of melanin in RPE makes the laser photocoagulation very challenging in these cases. This report presents a unique case of preterm infant of oculocutaneous albinism diagnosed as aggressive posterior retinopathy of prematurity (APROP), which was successfully treated with diode laser photocoagulation. The parameters of the laser used in this case were higher than usual, just enough to achieve blanching of retina. This report highlights the fact that the diagnosis of APROP and its treatment with laser is challenging in the presence of oculocutaneous albinism, but it is possible to achieve complete regression using diode laser at higher parameters.

Role of Calcium Toxicity in Neurodegenerative Diseases

Background: Neurodegenerative diseases are those affect the central nervous system (brain, spinal cord) and peripheral nervous system. It is characterized by progressive loss of neurons and synapses in these nervous systems. Calcium homeostasis receives key attention in the past few years in the field of neuronal physiology of Ageing and Neurodegenerative diseases. Objective: The aim of this study was to evaluate Calcium homeostasis in patients with Neurodegenerative diseases. Methods: 50 subjects (36 males and 14females) with Neurodegenerative diseases. And same number of healthy age-matched subject control group was assessed. A complete & detailed neurological examination were performed in all individuals and clinically evaluated for the occurrence of Neurodegenerative diseases. Calcium levels were estimated using (Instrumentation Laboratory – IlyteTM) Automated Electrolyte Analyzer, with solution pack and reagents. Results: ‘The Serum Calcium (Ca2+) levels were estimated and comparison was done in both control and case group separately, for evaluating the changes due to ageing and in particular to neurodegenerative diseases. Conclusion: Neurodegenerative diseases showed significant differences in Calcium homeostasis.

Evaluation of Brainstem Auditory Evoked Response (BAER) in Parkinson’s Disease

Background: Parkinson’s disease (PD) is a progressive long-term, neurodegenerative disorder of central nervous system which mainly affects the motor system, caused by loss of dopaminergic neurons in the substantia nigra, but also in other dopaminergic and non-dopaminergic areas of the brain and mainly in the brainstem. Brainstem Auditory Evoked Response are routinely used in clinical practice to evaluate the function of the auditory nerve and auditory pathways in the brainstem. Objective: The aim of this study was to evaluate the Brainstem Auditory Evoked Response in patients with Parkinson’s disease. Methods30 subjects (18 males and 12females) with Parkinson’s disease. And same number of healthy age-matched subject control group was assessed. Age of Control Group was 61.2±11.6 & of Test Group 61.7±10.4. A complete & detailed neurological examination (CNS) were performed in all individuals clinically especially of motor system to evaluate the severity of the disease for the occurrence of Parkinson’s disease. Recordings of BAERs were performed with Neurostim Plus software of Medicaid Company, using 70 dB HL in the form of rarefaction clicks were used in each ear obtain good quality BAER recording. Results. The BAER results were interpreted for the latencies and Interpeak latencies. The result of this study shows that the waves II, III, IV, V and IPL III-V were significantly delayed. Conclusion. Parkinson’s disease population showed significant differences to Brainstem Auditory Evoked Response

Giant mediastinal haemangiopericytoma: An uncommon case.

Haemangiopericytoma is a rare soft tissue tumour characterised by tightly packed tumour cells situated around thin walled endothelial lined vascular channels, ranging from capillary sized vessels to large gaping sinusoidal spaces. The tumour cells are surrounded by reticulin and are negative for muscle, nerve and epithelial markers. The diagnosis of extra-pulmonary intra-thoracic, extra-pleural mediastinal mass is difficult. It constitutes only 6% of all primary tumours and cysts of the mediastinum. We report the rare occurrence of primary intra-thoracic, extra-pulmonary mediastinal haemangiopericytoma of mesenchymal origin with perivascular localisation. The patient underwent right postero-lateral thoracotomy and postoperatively received chemotherapy with adriamycin (60 mg/m2) on day 1 and ifosfamide (1.5 g/m2) on day 1 to 3. Thirtyseven months after the operation, the patient has been well with evidence of a single recurrence in the left lower lobe.

Wandering Distal End of Ventriculo-Peritoneal Shunt: Our Experience with Five Cases and Review of Literature.

Ventriculo-peritoneal (VP) shunt is the most commonly performed procedure for the management of hydrocephalus. Although shunts have improved the morbidity and mortality associated with disordered Cerebrospinal fluid (CSF) mechanics over the past 30 years, they still are associated with many potentially avoidable complications in clinical practice. However, extrusion of VP shunt catheter is an unusual complication of VP shunt Surgery. We are presenting this unusual complication in five patients. The lower end of the shunt was seen extruding from anal opening in one patient, umbilicus in one, urethra in one, inguinal hernia sac in one and oral cavity in one patient. All of these patients were managed by shunt removal, intra venous antibiotics followed by shunt replacement on the other side except the patient with inguinal hernia sac.

Gamma knife radiosurgery for glomus jugulare tumors: Therapeutic advantages of minimalism in the skull base.

Context: Glomus jugulare (GJ) tumors are paragangliomas found in the region of the jugular foramen. Surgery with/without embolization and conventional radiotherapy has been the traditional management option. Aim: To analyze the efficacy of gamma knife radiosurgery (GKS) as a primary or an adjunctive form of therapy. Settings and Design: A retrospective analysis of patients who received GKS at a tertiary neurosurgical center was performed. Materials and Methods: Of the 1601 patients who underwent GKS from 1997 to 2006, 24 patients with GJ underwent 25 procedures. Results: The average age of the cohort was 46.6 years (range, 22-76 years) and the male to female ratio was 1:2. The most common neurological deficit was IX, X, XI cranial nerve paresis (15/24). Fifteen patients received primary GKS. Mean tumor size was 8.7 cc (range 1.1-17.2 cc). The coverage achieved was 93.1% (range 90-97%) using a mean tumor margin dose of 16.4 Gy (range 12-25 Gy) at a mean isodose of 49.5% (range 45-50%). Thirteen patients (six primary and seven secondary) were available for follow-up at a median interval of 24 months (range seven to 48 months). The average tumor size was 7.9 cc (range 1.1-17.2 cc). Using a mean tumor margin dose of 16.3 Gy (range 12-20 Gy) 93.6% coverage (range 91-97%) was achieved. Six patients improved clinically. A single patient developed transient trigeminal neuralgia. Magnetic resonance imaging follow-up was available for 10 patients; seven recorded a decrease in size. There was no tumor progression. Conclusions: Gamma knife radiosurgery is a safe and effective primary and secondary modality of treatment for GJ.

Uncommon parathyroid mediastinal cyst compressing the trachea.

Mediastinal parathyroid cyst is a rare cause of space occupying lesion in the mediastinum. No specific symptomatology may be attributed to the non-functioning parathyroid cyst. The diagnosis is rarely made before exploration. The cysts are thin walled, smooth, of varying sizes and contained clear, opalescent or haemorrhagic fluid. Histopathological examination reveals clusters of parathyroid cells dispersed in the wall of the cyst. Surgical removal is the treatment of choice and can be performed with minimal morbidity.

Pulmonary hyalinizing granuloma with ureteric fibrosis: A case report and review of relevant literature.

A 52-year-old, asymptomatic patient presented with bilateral lung nodules on chest radiograph. She was diagnosed to have "pulmonary hyalinizing granuloma" on an open lung biopsy. We review the clinical features of this rare disease.

Efficacy and results of expansive laminoplasty in patients with severe cervical myelopathy due to cervical canal stenosis.

AIMS AND OBJECTIVES: To assess the efficacy and results of expansive laminoplasty in advanced (Nurick's Grade III or greater) cervical myelopathy. MATERIALS AND METHODS: We reviewed data in 24 patients who underwent cervical laminoplasty from January 1999 to December 2002. Nuricks grading was used for quantifying the neurological deficits and outcome analysis was done using Odom's criteria. A modified Hirabayashi's open door laminoplasty was done using Titanium miniplates and screws in 22 patients, autologous bone in one and hydroxyapatite spacer in one patient. OBSERVATIONS: There were 3 females and 21 males with a mean age of 56 years (range 39-72 years). Four patients presented in Nuricks Grade III, 15 in Grade IV and five in Grade V. MR imaging showed MSCS in 21 cases, OPLL in nine cases and ligamentum flavum hypertrophy in nine cases with cord signal changes being present in 19 cases. RESULTS: All patients with duration of symptoms less than three years, and 50 % with duration ranging from three to six years had improvement by at least one Nurick's grade following surgery. Eighty-seven per cent Grade IV patients (ambulatory with support) improved to Grade III (ambulatory without support) following laminoplasty. Using Odom's criteria, 23 patients (95.8%) had a good to fair outcome. CONCLUSIONS: Cord decompression with expansive laminoplasty using titanium miniplate fixation may improve the neurological outcome even in patients presenting late, and improvement by even one grade may have major 'quality of life' benefits for these patients.

Spontaneous subdural hematoma in a young adult with hemophilia.

We report a case of spontaneous acute subdural hematoma in a 30-year-old man, who was diagnosed with hemophilia during his hospital stay. He developed an extradural hematoma following evacuation of the acute SDH, which was also evacuated. He had a good outcome. Management of such a patient is discussed.

Pure red cell aplasia associated with thymoma.

A case of thymoma with mixed spindle and lymphocytic variety along with acquired, secondary, chronic pure red cell aplasia is an uncommon entity. The presented case is a case of anterior mediastinal tumour with marked anemia. On histopathologic and hematological examinations, it proved to be a case of thymoma along with pure red cell aplasia. High index of suspicion, bone marrow examination, radiological including CT scan examination, total thymectomy after preparation with repeated blood transfusion remains the mainstay of treatment. Prolonged corticosteroid therapy leads to remission for upto ten months after operative intervention.

Post-cardiotomy intra-aortic balloon counter pulsation: application and prognostic evaluation.

Cardiac assistance by intra-aortic balloon counter pulsation was studied in 113 cardiac surgical cases comprising 91 male and 22 female patients. This included 82 percent of patients having coronary artery bypass surgery, while 18 percent were operated for valvular lesions. It was observed that the time of institution of cardiac assistance by intra-aortic balloon counter pulsation, following cardiac surgery, was of prime importance to decrease patient mortality. It was lowest (16%) when the balloon was inserted for assistance before termination and highest (50%) when there was delay of more than 15 minutes following termination of cardiopulmonary bypass. Early balloon assistance significantly lowered the pulmonary capillary wedge pressure and usually 1:2 augmentation was more effective, probably because of existing tachycardia in most patients. Advances in catheter technology have reduced the vascular complication at the insertion site. Percutaneous insertion had less local complications (13.3%) than open arteriotomy technique (31.2%). Similarly with sheathless insertion, complications were less (6.6%) in comparison to sheathed insertion (21.7%). Proper placement of balloon avoided position-related complications and there was no compromise of blood flow through left internal mammary artery as noticed in our series.