Morphometric Aspects of the Jugular Foramen and Jugular Fossa in Dry Skulls of Central India

Jugular foramen is a large irregular hiatus at the base of the skull which transmits a large number of important structures. Any abnormality of jugular foramen and associated jugular fossa may impart damage to these structures. Aim of the present study was to analyse the shape, size, presence of septa, presence of a domed bony roof and bilateral symmetry of the Jugular foramen in dry adult skulls of males and females in the central Indian population. METHODSA total of 120 skull jugular foramina and jugular fossae were examined, by two different researchers to avoid observer errors. Parameters studied were anteroposterior and transverse diameters of jugular foramen, width and depth of jugular fossa, presence of bony septum etc. Data was collected and analysed using statistical software. RESULTSAntero-posterior and transverse diameters of right jugular foramen were found to be more than left one. Complete septation of jugular foramen was observed in 1.67 % and 2.5 % skulls on right and left side respectively. Bony roof or dome of jugular fossa was observed in 30 %, 17.5 % and 16.67 % on the right side, the left side, and bilaterally respectively. In 10.83 % skulls, we found an accessory foramen connecting jugular foramen to anterior condylar canal. CONCLUSIONSDetailed knowledge of various anomalies of jugular fossa and jugular foramen should be kept in mind while doing surgery by neurosurgeons and ENT surgeons. Radiologists also should keep these points in the mind while interpreting CT and MRI scans.

Morphology Of Suprascapular Notch And Its Clinical Significance

Introduction: The suprascapular notch is present on the superior border of the scapula, just medial to thecoracoid process. The suprascapular ligament bridges the edges of notch, which sometimes get ossified andconvert suprascapular notch into foramen.A narrow notch or excess ossified ligament may have a greaterchance of a nerve impingement in the suprascapular foramen.Materials and methods: This study was conducted on the bones that were obtained from the bone bank ofDepartment of Anatomy. A total of 118 (57 right, 61 left) human scapulae derived from adult (35 male and 17female) skeletons were evaluated for the shape of suprascapular notch ,presence of any ossification of thesuprascapular ligament and classified according to Rengachary et al into I –VI types.Results: On analysis of morphological variations of suprascapular notch, we found following types of scapulae:Type I -22.42 %, Type II -12.98 %, Type III -53.98 %, Type IV -0 %, Type V- 7.08 %, Type VI -3.54%.. Out of all specimens,in three specimen suprascapular ligaments (3.54 %) were found to be completely ossifiedConclusion: The knowledge of morphometric variations of suprascapular notch and ossification of suprascapularligament is very important for clinicians. This knowledge is very important in sports medicine as well as fororthopaedic surgeons in management of cases of shoulder pain.

Impact of coronary artery disease on augmentation index as measured by estimated central blood pressure: A case control study in Asian Indians

Aims We compared various components of blood pressure and arterial stiffness of healthy control with those of coronary artery disease (CAD) patients using BP+ machine™. Methods In this prospective, case-control study, total 585 individuals of both the genders were enrolled. The study population consisted of 277 controls (healthy siblings of diseased subjects not having CAD – group A) and 308 CAD patients (group B). Age and sex adjusted regression and receiver operative curve (ROC) analysis was performed to assess the strength of association of these parameters. Results We found that mean systolic blood pressure (SBP) (137.14 ± 22.49 vs. 129.26 ± 19.86), central systolic blood pressure (CSBP) (130.78 ± 21.89 vs. 117.53 ± 17.98), augmentation index (AI) (108.55 ± 44.98 vs. 49.38 ± 21.03) and pulse rate variability (98.82 ± 231.09 vs. 82.86 ± 208.77) were significantly (p < 0.05) higher in CAD population as compared to healthy counterparts. Left ventricular contractibility as measured by dP/dt was significantly lower in CAD patients. All these parameters were significantly abnormal in CAD as compared to healthy control population irrespective of the gender of the patient except for SBP in females. Both – odds ratio (1.108; 95% CI: 1.081–1.135; p < 0.0001) and ROC analysis (AUC: 0.937; 95% CI: 0.919–0.956; p < 0.0001) showed AI as the strongest predictor of CAD, closely followed by CSBP. Conclusion Central aortic blood pressure parameters such as AI and CSBP measured noninvasively with BP+ machine could be the effective predictors of CAD in Asian Indians.

Assessment of serum cardiac troponin-I over serum CPK-MB in early diagnosis of acute myocardial infarction (AMI)

Background: The early mortality rate from AMI is 30% with about half of them occurring within 1hour of disability. Although the mortality rate after admission for AMI has declined by 30% over the past decades, approximately 1 of every 25 patients who survive the initial hospitalization die in the first year after AMI. The gold standard for diagnosis of MI has been an elevated serum level of creatinine kinase – myocardial band (CK- MB), the cardiac-specific isoenzyme of CK. However, elevated CK-MB may not detect all myocardial necrosis. In patients who die suddenly after severe or silent episodes of ischemia, autopsies frequently reveal micronecrosis that was not reflected in routine CK-MB measurements. The present study was undertaken to know that serum Cardiac Troponin-I is more sensitive marker than serum CPK-MB in early diagnosis of acute myocardial infarction (AMI).Methods: The study was carried out in tertiary care hospital in Gulbarga. The study was undertaken with an aim to study that serum cardiac troponin-I (cTnl) is more sensitive than serum CK-MB in early diagnosis of acute myocardial infarction (AMI). The study was conducted on patients admitted with history of chest pain suggestive of AMI as diagnosed by WHO criteria to medicine ward of Basaveshwar Teaching and General Hospital, Gulbarga. The period of study was from June 2012 to June 2014. The sample size included 100 patients with history of chest pain suggestive of AMI, selected by simple random method.Results: Our results revealed that cardiac troponin I was more sensitive (62%) than CK-MB in overall cases admitted in between 6-24 hrs from the onset of chest pain. Maximum number (41%) of AMI patients were affected on the anterior wall followed by Inferior wall of AMI. 11 percent were affected with Antero lateral wall wereas 5 to 6 percent were affected with anteroseptal and global acute and right ventricular AMI was seen among 2 percent of patients. Anterior wall AMI was the significantly affected site with AMI (ʎ2:12.5, P:0.0004). The maximum number of acute myocardial infarctions were ST elevation myocardial infarctions. 28% of cases where CKMB is normal, the cTnI detects the AMI cases indicating its sensitivity.Conclusions: Cardiac troponin-I (cTnI) was more sensitive serum marker than CKMB in the early diagnosis of acute myocardial infarction (AMI). Anterior wall was the most significantly affected site of AMI. In the future, further improvements in analytical performance may open additional diagnostic windows

Klingler’s Fiber Dissection Method- An Assisting Approach Towards Teaching Neuroanatomy

Background and Objective: The Klingler fiber dissection technique is a simple and less complicated method foridentifying the fine structure of the white fiber tracts of brain. In this study, we have used classical fiber dissectiontechnique by Klinger’s to produce white matter specimens which can be used for explaining anatomy of variouswhite matter tracts to students.Materials and Methods: Five brains specimen removed from formalin fixed human cadavers (3 males and 2female) were used in this study. Klinger’s fibers dissection method was used to obtain white fibers specimen.Dissection of the cerebrum was performed using wooden spatulas, fine curved metal spatulas, fine forceps. Thewhite fibers were exposed by peeling brain with help of wooden spatula to expose the fibers. The dissectionmicroscope was used to isolate small structures.Results: Using the classical Klinger’s technique, we were able to obtain a brain specimen depicting organizationof various white fibres such as corona radiata, superior longitudinal bundle, association fibres with fibrespassing in relation to lentiform nucleus. In another specimen, dissection of right cerebral hemisphere medial tolentiform nucleus showed continuity of white projection fibres of corona radiata as internal capsule. Fibres ofcorpus callosum were delineated in two specimens which displayed spatial disposition of its various parts.Conclusion: White matter fiber of brain are very important for understanding of function of the central nervoussystem function. The Klingler’s fiber dissection technique with other study material can successfully serve thepurpose of the teaching of complex brain architecture of white matter. These dissected specimens will be moreattractive to students, than the mere imagination of white fiber tracts during neuroanatomy classes.

Bedside Index of Severity in Acute Pancreatitis (BISAP) score for predicting prognosis in acute pancreatitis.

Introduction: Bedside Index of Severity in Acute Pancreatitis (BISAP) is a simple bedside tool which helps in early identification of risk of higher mortality in acute pancreatitis. Objectives: Our aim was to study clinical and laboratory profiles of patients with acute pancreatitis presenting to a tertiary care hospital in Mumbai, India and to stratify patients according to their risk of mortality by applying the BISAP score and its correlation with Computed Tomography Severity Index (CTSI). Material and methods: Patients who came to Lokmanya Tilak Municipal Medical College (LTMMC) and General Hospital, Mumbai with definitive features of acute pancreatitis from January, 2013 to April, 2013 were prospectively observed for 24 hours and their clinical information was collected. CT abdomen was used as the gold standard for the diagnosis of acute pancreatitis. Descriptive analysis for various patient variables was performed using SPSS. Results: Alcoholism was the most common etiology; 97% patients presented with abdominal pain. Higher serum amylase, lipase and blood urea nitrogen levels, hypocalcemia, presence of systemic inflammatory response syndrome and bilateral pleural effusion were found to significantly associate with mortality. There was a statistically significant trend for increasing mortality with increasing BISAP score (p<0.001). However, no significant correlation between BISAP score and CTSI was found [(p = 0.101), Pearson’s correlation coefficient = 0.168]. Conclusion: Traditional severity indices have not been clinically useful since they require collection of huge amount of clinical and laboratory data over time. In such circumstances, BISAP score can predict patients who are at higher risk of mortality.

Morphological Study of Human Liver and Its Surgical Importance.

Background: The liver is largest abdominal viscera located in right hypochondrium ,epigastrium and left hypochondrium in upper abdominal cavity. Although the segmental anatomy of the liver has been extensively researched, very few studies have dealt with surface variations of the liver. The major fissures are important landmarks for interpreting the lobar anatomy and locating the liver lesions. Purpose: The purpose of our study was to determine gross anatomical variations of liver and their clinical and surgical implications. Methods and Results: Present morphological study was conducted on 50 embalmed human livers in the Department of Anatomy, Maulana Azad Medical College, New Delhi,India. Different variations in lobes, fissures and accessory lobes or fissures were observed. The liver specimens were also classified according to netter’s six types of liver variations. Conclusion: The findings of our study may be helpful for surgeons and radiologist to avoid possible errors in interpretations and subsequent misdiagnosis, and to assist in planning appropriate surgical approaches.

Origin of cystic artery from hepatic artery proper and its surgical implications.

Cystic artery is usually a branch of right hepatic artery given in the Calot’s triangle. Variations in the origin of cystic artery have been reported but there is paucity of literature regarding these in Indian subjects. The present case describes the origin of cystic artery from the hepatic artery proper, with an unusual course, which was detected during routine cadaveric dissection. The development of biliary vasculature is quite complex and it accounts for many variations. Knowledge of cystic artery variability facilitates intraoperative identification of vessels in both classical and laparoscopic surgery of the bile ducts. This emphasises the importance of a thorough knowledge of the cystic arterial variations that often occur and may be encountered during both laparoscopic and open cholecystectomy. Uncontrolled bleeding from the cystic artery and its branches is a serious problem that may increase the risk of intraoperative lesions to vital vascular and biliary structures during hepatobiliary surgery.

Predictors of prolonged mechanical ventilation after on-pump coronary artery bypass grafting.

The predictors of prolonged mechanical ventilation and subsequent morbidity after cardiac surgery are ill defined. Our aim was to evaluate them. Four hundred and seventy consecutive patients undergoing coronary artery bypass grafting on cardiopulmonary bypass (CPB) between January and June 2002 were retrospectively analysed for preoperative predictors of prolonged ventilation, which included age, gender, ejection fraction (EF), renal function, diabetes, angina status, severity of the disease (New York Heart Association class), number of vessels diseased and chronic lung disease. Intraoperative variables such as prolonged CPB, aortic cross clamp time, intra-aortic balloon pump (IABP) usage, inotropes and postoperative variables like temperature on arrival at intensive care unit(ICU), IABP usage, organ dysfunction, inotropes and reintervention (reintubation and re-exploration) were also analysed. Prolonged ventilation was defined as > or = 24 hours and these patients were included in group I (n=22). Patients requiring less than 24 hours ventilation (n=448) were included in group II. Stepwise logistic regression analysis was performed. The average age of patients was 56.9 +/- 8.8 years with male predominance (88.4%). The overall perioperative mortality was 2.1% (10 patients) with Group I showing mortality rate of 36.3% (8 patients). In multivariate analysis, predictors of prolonged ventilation were found to be EF <40% (odds ratio, (OR) 13.38), preoperative renal dysfunction [OR 4.06 (serum creatinine > 1.2 mg%)], prolonged CPB, > 120 min (OR 9.6) and reintervention in the form of re-exploration or reintubation in the ICU (OR 13.8). Identification of perioperative variables, which may lead to prolonged ventilation may allow the development of strategies to optimize the patient's condition and ICU management.