A Comparative Study Of Number And Position Of Papillary Muscles And Clinical Significance

Introduction: Papillary muscles are the conical muscle masses project into the cavity of ventricle and areinserted into the valve cusps by chordae tendinae. They prevent the cusps from being forced back into the atriumduring ventricular contraction. Their number and positions are highly variable. An anomalous papillary musclecan act as an ectopic foci. Hence these variations should be assessed before any operative intervention on thevalve. Present study aim to analyse these variations in detail.Materials and Methods: This is a descriptive observational study to analyse the variations in number andposition of papillary muscles in ventricles of 100 adult human hearts ranging in age from 17 to 80 yearsobtained from autopsy specimens. The methodology used was the dissection method according to standardautopsy techniques. The data obtained were quantified as frequencies (in %).Results: Of the 100 hearts studied, the right ventricle consisted of the usual three groups of papillary muscles in84% of hearts whereas the remaining 16% of hearts had only two groups (rudimentary SPMs). The left ventricleconsisted of two groups of papillary muscles in 73% of hearts ; three groups in 23%; four groups in 4% and noneof the hearts contained single papillary muscle. Regarding the positions, the right ventricle had APMs inanterobasal position, the PPMs in posterobasal position and SPMs was located close to ventricular septum andno extra group of papillary muscles were found. In left ventricle, 73% of hearts had APMs and PPMs in anterolateraland posteromedial positions respectively, whereas in 27% (23% and 4%) hearts, the extra group of papillarymuscles (third group and fourth group) were interlinked to PPMs and was situated in posterolateral position.Conclusion: These findings suggest that the variations in number and positions of papillary muscles should beanticipated before any operative intervention on the valvular apparatus.

Biomechanical Assessment of Stabilization of Simulated Type II Odontoid Fracture with Case Study

STUDY DESIGN: Researchers created a proper type II dens fracture (DF) and quantified a novel current posterior fixation technique with spacers at C1–C2. A clinical case study supplements this biomechanical analysis. PURPOSE: Researchers explored their hypothesis that spacers combined with posterior instrumentation (PI) reduce range of motion significantly, possibly leading to better fusion outcomes. OVERVIEW OF LITERATURE: Literature shows that the atlantoaxial joint is unique in allowing segmental rotary motion, enabling head turning. With no intervertebral discs at these joints, multiple ligaments bind the axis to the skull base and to the atlas; an intact odontoid (dens) enhances stability. The most common traumatic injury at these strong ligaments is a type II odontoid fracture. METHODS: Each of seven specimens (C0–C3) was tested on a custom-built six-degrees-of-freedom spine simulator with constructs of intact state, type II DF, C1–C2 PI, PI with joint capsulotomy (PIJC), PI with spacers (PIS) at C1–C2, and spacers alone (SA). A bending moment of 2.0 Nm (1.5°/sec) was applied in flexion-extension (FE), lateral bending (LB), and axial rotation (AR). One-way analysis of variance with repeated measures was performed. RESULTS: DF increased motion to 320%, 429%, and 120% versus intact (FE, LB, and AR, respectively). PI significantly reduced motion to 41%, 21%, and 8%. PIJC showed negligible changes from PI. PIS reduced motion to 16%, 14%, and 3%. SA decreased motion to 64%, 24%, and 54%. Reduced motion facilitated solid fusion in an 89-year-old female patient within 1 year. CONCLUSIONS: Type II odontoid fractures can lead to acute or chronic instability. Current fixation techniques use C1–C2 PI or an anterior dens screw. Addition of spacers alongside PI led to increased biomechanical rigidity over intact motion and may offer an alternative to established surgical fixation techniques.

Cryptogenic cirrhosis: Metabolic liver disease due to insulin resistance.

Objective: Etiopathogenesis of cryptogenic cirrhosis (CC) is not yet well established. Up to 20% of non-alcoholic fatty liver disease (NAFLD) may progress to cirrhosis, mostly termed as cryptogenic. Insulin resistance and altered metabolic parameters form a major pathogenic link between NAFLD and CC. CC may thus be actually a metabolic liver disease. Materials and Methods: Thirty-four patients of CC and 32 patients having cirrhosis due to chronic hepatitis B (Hep B) were assessed in a cross-sectional study in a tertiary hospital for insulin resistance, % β-cell activity, obesity indices, plasma glucose, lipid profiles, and many other parameters. Results: CC patients had higher homeostasis model assessment (HOMA)-IR compared to Hep B group (P = 0.000016). A positive correlation between IR values and Child-Pugh score among CC patients was found ("r" = 0.87; P < 0.00001). Out of 34 CC patients, 15 (44.1%) had obesity contrary to 6 (18.8%) in the control group (P = 0.0022). Differences were observed in subcutaneous fat (P = 0.0022), intra-abdominal fat (P = 0.0055), waist circumference (P = 0.014), and percentage body fat (P = 0.047) between the two groups. Significant differences were observed in the levels of triglyceride, total cholesterol, and very low density lipoprotein (VLDL). Conclusion: Most of the CC patients showed significantly higher prevalence of HOMA-IR, obesity indices, and various parameters of "lipotoxicity" and metabolic syndrome, suggesting that CC may be the long-term consequence of a type of "metabolic liver disease." Further studies are required to evaluate the role of therapeutic interventions to enhance insulin sensitivity in such patients.

Case report of two sisters suffering from Weill-Marchesani syndrome with pulmonary stenosis.

We report two sisters having a rare congenital anomaly-Weill-Marchesani syndrome having disproportionate short height, restriction of joint movements, brachydactyly, dislocation of lens, bilateral glaucomatous optic atrophy, and pulmonary stenosis.

Serum paraoxonase 1 activity status in patients with liver disorders

Paraoxonase 1 [PON1] is an esterase, exclusively synthesized by liver. The present study has two objectives: to determine the PON1 activity status in various disorders associated with hepatocellular damage and to correlate the changes of PON1 activity with the standard liver function and fasting lipid profile tests in these disorders. The study groups consisted of 95 patients with liver diseases including acute viral hepatitis [14], cirrhosis with portal hypertension [33], leptospirosis [14], sepsis and multi organ failure [15], left ventricular failure [9], and falciparum malaria [10]; and 53 healthy controls. Serum PON1 activity was measured manually using spectrophotometer. Liver function test parameters and fasting lipid profile were performed in clinical chemistry auto analyzer [HITACHI 912]. The serum PON1 activity in patients with acute viral hepatitis and sepsis decreased significantly [P<0.001] and moderately in falciparum malaria [P<0.05]. However, in patients with cirrhosis, leptospirosis and left ventricular patients, its activity did not change significantly. On applying Pearson correlation, serum PON1 activity correlated positively with high-density lipoprotein-cholesterol [HDL-C] in patients with sepsis [r=0.633, P<0.05], left ventricular failure patients [r=0.814, P<0.05] and negatively with acute viral hepatitis patients [r=-0.528, P<0.05]. PON1 activity has decreased significantly in acute viral hepatitis, sepsis with multi organ failure and falciparum malaria patients. Determination of PON1 activity may serve as a useful additional test in assessing these conditions

Incontinentia pigmenti.

Incontinentia pigmenti or Bloch-Sulzberger syndrome, is a rare X linked dominant disorder with characteristic skin, hair, eye, dental and neurological abnormalities commonly affecting females. This article reports the clinical features and management of a 11 year old girl diagnosed with Incontinentia pigmenti.