Anatomy of left atrioventricular valve (mitral valve) leaflets in adult Indian cadavers / Anatomía de los velos valvulares en la valva atrioventricular izquierda (válvula mitral) en cadáveres indios adultos

The atrioventricular valve is the most commonly repaired valve of the heart. Interventional procedures like annuloplasties, valvotomy/valvuloplasty, repair/replacement of the valve for regurgitation or prolapse are increasing by the day. This necessitates a clear understanding of the mitral valve anatomy. The present study is an attempt to revisit the anatomy of mitral valve. The present study was conducted on 34 adult embalmed heart specimens. Based on the newly defined criteria, observations were made on: 1) Number of commissures and their positions, 2) Number and position of leaflets, 3) Number and position of minor commissures, 4) Annular circumference (AC), 5) Length of annular attachment of each leaflet (LAA), 6) Maximum width of coapted/ folded margin (FM) of the anterior and posterior leaflet, 7) The surface area of each leaflet (SA). The observations were analyzed statistically. The findings of the present study and the subsequent statistical analysis offer a dynamic concept of the anatomy of mitral valve leaflets. It suggests that the valvular anatomy depends upon a complex interplay of various valve components. The extra leaflets tend to occur when annular circumference increases and is not appropriately compensated by various valvular elements. The different methodology adopted in the present study and the interpretations deduced hereupon, shall dispel the existing ambiguities in the description of the leaflets and improve our understanding of the structure and function of the mitral valve complex.

La valva atrioventricular es la valva más comúnmente reparada del corazón. Los procedimientos intervencionistas como anuloplastías, valvotomía/valvoplastía, reparación/reemplazo de la valva por la regurgitación o prolapso están aumentando día a día. Para ello, se requiere una clara comprensión de la anatomía de la valva atrioventricular. El presente estudio intenta volver a examinar la anatomía de la valva atrioventricular. Se estudiaron 34 corazones de adultos embalsamados. Sobre la base de los criterios definidos, se realizaron las siguientes observaciones: 1) número de comisuras y sus posiciones, 2) número y localización de los velos, 3) número y localización de las comisuras menores, 4) circunferencia anular (AC), 5) longitud de la unión anular de cada valva (LAA), 6) ancho máximo del margen de coaptación/margen velar (FM) de los velos anterior y posterior y 7) área de superficie de cada valva (SA). Las observaciones fueron analizadas estadísticamente. Los resultados del presente estudio y el análisis estadístico ofrecen un concepto dinámico de la anatomía de la valva atrioventricular. Se sugiere que la anatomía de las valvas depende de una interacción compleja de varios de sus componentes. Los velos adicionales tienden a aparecer cuando aumenta la circunferencia anulares y no se compensa adecuadamente por diversos elementos valvares. La diferente metodología adoptada en el presente estudio sus interpretaciones, podrían disipar ambigüedades existentes en la descripción de las valvas y mejorar nuestra comprensión de la estructura y función del complejo de la valva atrioventricular.

Role of forensic medicine in administration of justice a critical review.

Two small round opaque shadows of metallic densities opined as that the injury was not a firearm injury but was self inflicted one by the first Medical Board under the Chairmanship of Chief Medical Officer. Opinion of another Medical Board comprising Forensic Medicine expert considered it as a: Clear cut case of firearm wound. Based on two contradictory opinions, Allahabad Court held that the Charge: sheet submitted under sections 323, 504, and 506 IPC, ought to have been submitted under some graver sections too. This paper deals with a critical review of case where two Medical Boards were constituted in the interest of justice. Views of various other relevant judgments of Hon’ble Supreme Court and various High Courts emphasizes the importance of Forensic Medicine in the administration of justice and need for refresher courses and training for medical officers suggested to avoid future recurrences of such nature are discussed in brief.

Importance of scene of crime visit, it may be late, but it is never too late.

A male aged about 75 years was found dead in his residence. When police arrived to the scene of incidence by information of relatives, he founds body was lying down in supine position on the floor with ligature mark around the neck and deeply congested protruded tongue from the mouth, eyes widely open, left hand lying on abdomen and right resting on the floor. During initial investigation Police relying on the history given by the servant and relatives presumed that it to be case of suicide. But he did not find any reason for suicide. Under dubious nature of case police become bound to take the forensic expert opinion after 6 days of intensive investigation. A team of forensic experts (authors of this paper) visited and scientifically examined the scene of incidence and gave their expert opinion to solve the case.

Fatal road traffic accidents, study of distribution, nature and type of injury.

During one year study period medico legal autopsies were conducted on 950 cases of fatal road traffic accidents at the mortuary of SRN Hospital, MLN Medical College, Allahabad. M/F ratio 3:1. 33.68% of cases were in the age group of 25-44 years. Pedestrians were most vulnerable accounting for 35.79% of total fatalities followed by motorized two wheelers 30.53%. Heavy Vehicles were found to be mostly involved 58.52% of cases and most accidents 83.05% occurred on highways. Majority of cases sustained multiple injuries. Primary impact injuries were recorded in 455 cases and pedestrians 36.26% were mostly affected followed by pedal cyclists 20.88%. 505 cases sustained secondary impact injuries and pedestrians and motor cyclists were primarily involved. Of 697 secondary injuries, 29.99% were sustained by motorcyclists followed by pediastrians 22.67%. Mostly lower extremities 27.39% and pelvis 25.99% received the primary impacts; the head and neck 55.62% the secondary impacts, while secondary injuries were mostly located in the lower extremities 28.38%. Largest number of injuries were recorded in lower extremities 804 number, followed by head & neck 748 number. Vehicle occupants mostly sustained thoracic injuries. In majority of cases, the site of initial impact of the responsible vehicle was frontal (45.14%) followed by rear (25.83%) and side (7.01%). In 179 cases (22.02%) site of responsible vehicle were not known.

Histopathological changes in cases of aluminium phosphide poisoning.

Of a total of 205 poisoning deaths in our hospital in 2003, 83 cases were due to Aluminium phosphide poisoning and were further analyzed. Most vulnerable age group was 21-40 years and M:F ratio was 2:1. On naked eye examination, almost all the vital organs were found to be congested. On microscopic study, the liver showed central venous congestion, degeneration, haemorrhage, sinusoidal dilation, bile stasis, centrilobular necrosis, Kupffer cell hyperplasia, infiltration by mononuclear cells and fatty change. Microscopy of the lungs revealed alveolar thickening, oedema, dilated capillaries, collapsed alveoli and haemorrhage. In the kidney, changes were degeneration, infiltration, tubular dilation and cloudy swelling. Changes in the brain included congestion and coagulative necrosis and in the stomach, congestion and haemorrhage. Easy availability of this cheap and highly toxic substance was responsible for the sudden spurt of poisoning with aluminium phosphide.

Age specific incidence rate and pathological spectrum of oral cancer in Allahabad.

BACKGROUND: Cancer of the oral cavity is one of the commonest cancers in India. Use of smokeless tobacco (Pan masala, Zarda etc ) is on the increase in North India and specially in Uttar Pradesh. AIMS: To assess the patients characteristics and histopathological subtypes of the oral cancer in our region. SETTINGS AND DESIGN: A single institutional retrospective study of 11 years from 1990 to 2000 was designed. Data was collected year wise using the tumour registry data. MATERIAL AND METHODS: A total of 40,559 biopsies were examined in the department during 1990-2000, out of which the oral cavity constituted 759 biopsies. The data was analysed with emphasis on age, sex, risk factors, site and histology. STATISTICAL ANALYSIS: The data was analysed utilizing the Kolomogroo-Smirnov two sample test. RESULTS: A comparison of the age specific incidence rates of oral cancer during 1990-2000 in Allahabad showed that the incidence was maximum in the 50-59 years age group and squamous cell carcinoma grade I was the most prevalent type. Of the total of 759 biopsies from oral cavity, 303 malignant cases. 232 (76.57%) were males and 71 (23.43% were females with a male to female ratio of 3.27:1. The tongue was the most frequently involved site--found in 42.57% cases. On an average, 63 new cases of oral cavity per annum were detected during this period. CONCLUSIONS: Properly structured site specific data like this can augment National Cancer Registry Programme (NCRP) and is an essential indicator for the magnitude and the pattern of the cancer problem in India Urgent public health measures like public education and oral cancer awareness are required to curb this avoidable epidemic.