A study of histopathological spectrum of central nervous system lesions at a tertiary health care center of South Gujarat, India

Background: Central nervous system lesions can have varied aetiology like infectious, inflammatory and neoplastic. Establishing an accurate aetiology is essential for timely diagnosis and neurosurgical intervention. The annual incidence of tumours of CNS ranges from 10 to 17 per 100,000 people for intracranial tumours and 1 to 2 per 100,000 people for intraspinal tumours; the majority of these are primary tumours, and only one fourth to one half are metastastic. The present study attempts to provide preliminary data on morphological patterns of intracranial lesions and to study clinicopathological spectrum.Methods: The present study was carried out at a tertiary care center from January 2015 to September 2017. A total of 65 cases of CNS lesions were analyzed. In case of CNS tumours reporting were done according to WHO criteria for classification and grading.Results: Out of 65 cases studied, 51 cases (78.46%) were of neoplastic lesions and 14 cases (21.54%) of non-neoplastic lesions. Among 14 cases of non-neoplastic lesions 2 cases were of reactive/cystic lesions, 4 cases  were of infective lesions, and 8 cases were of congenital lesions. In the present study, out of 51 neoplastic cases most common cases were of astrocytoma.Conclusions: The exact histopathological diagnosis of Central Nervous system lesions is essential to predict the prognosis and treatment. Management strategies and prognosis of tumours depends on the correlation of factors like the types, grades of tumours, its location, size and stage of development.

Estimation of Total Femoral Length from EpicondylarBreadth of Femur

Introduction: Stature is an important tool for identification and unique data of human being. Estimation of stature from bones is important for forensic as well as anthropological studies. It is necessary to derive the regression equations from the fragments of femur for medico legal situations. Thus from lower end of femur, estimation of total femoral length can be calculated and then this can be used to get stature by deriving statural formulae. In this study, regression equation for the estimation of total femoral length from epicondylar breadth of femur was computed. Subjects and Methods: Total 208 normal dry human femur bones which were preserved in antomy department of different medical colleges of Gujarat were studied. Total Femoral Length and Epicondylar Breadth of the Femur bone were measured for this study. Results: Epicondylar Breadth of femur displayed the higher correlation (0.828) with Total Femoral Length (TFL) for an individual measurement. As per regression analysis, regression equation is derived which is, B=338.004 + A * 1.390, Where A=Epicondylar Breadth of femur, and B= Total Femoral Length. Then the stature can be estimated by this total Femoral Length by the regression equations or the multiplication factors which are already established by various studies. Conclusion: The total Femoral Length can be estimated from fragmentary lower end of the femur. The total femoral length can be estimated by the equation presented in this study even in the absence of intact femur bone, and by which the stature can be estimated in sex and population sample.

Determination of Sex from Epicondylar Breadth of Femur

Introduction: Sex determination from skeletal remains allows one to narrow the search in individual identification. As the femur shows 75% Variation between individuals, it has been useful for sex determination. There are many possible femoral measurements, but the Epicondylar breadth is routinely considered to be useful for sexing individuals. To date, nothing has been published on other measurements of distal femur, which may be useful if the bone is fragmented, and only lower part of bone is available. This study is an attempt to evaluate sex determination from distal femora of Indian origin. Subjects and Methods: For this study total 208 normal dry human femur bones of known sex were studied, which were collected from various medical colleges of Gujarat. For measurement of Epicondylar breadth of femur, Digital sliding vernier caliper was used. Results: The discriminant function equation for sex determination from Epicondylar Breadth (EB) of femur is:-Y = 0.143 * EB + (-8.334) If Y is < 0 then the sex of the bone is Female and if Y is > 0 then the sex of the bone is Male. Conclusion: With the use of discriminant function score, 87% of femur samples are correctly predicted about sex. The results of this study is particularly useful in a case for sex determination in which the skeletal remains of an individual are incomplete or damaged and thus more accurate bones such as the pelvis or cranium are absent.

A Cadaveric Study of Variatons in the Origin of Lateral Circumflex Femoral Artery.

Introduction: The lateral circumflex femoral artery is a branch of the profunda femoris artery, which is the largest branch of femoral artery. The knowledge of origin and branching patterns of the lateral circumflex femoral artery is valuable for various surgeries and clinical procedures. Objectives: To determine mode of origin of lateral circumflex femoral artery and to determine the distance of origin of lateral circumflex femoral artery from the origin of profunda femoris artery and from mid-inguinal point. Materials and Method: 130 femoral triangles were studied and various measurements were noted and analysed from the department of anatomy of various Medical colleges of Gujarat. Result and conclusion: The lateral circumflex femoral artery originated from profunda femoris artery in 119 cases and from femoral artery in 11 cases. In most of the cases, the distance of origin of lateral circumflex femoral artery from the origin of profunda femoris artery was ranging from 11 to 40 mm on both the sides.

Study of ATD Angle, Finger Ridge Count in Pulmonar Tuberculosis Patients.

Objective: To determine whether the Dermatoglyphics parameters in Pulmonary tuberculosis patients (sputum smear positive cases) and normal healthy controls were differ or not. Materials and Methods: In present study 100 cases (77 males and 23 females) of Pulmonary tuberculosis (sputum smear positive) in the age group of 18 to 70 were collected and studied for Dermatoglyphics parameters such as ‘ATD’ angle, total and absolute finger ridge counts. These parameters of cases were compared to those of 100 unrelated healthy subjects (controls) and analyzed for statistical significance. Results and conclusion: In present study we observed decrease ‘ATD’ angle in both hands of male and female cases as compared to controls that difference was statistically highly significant. There were no statistically significant difference observed in total finger ridge count (TFRC) and absolute finger ridge count (AFRC) of cases compared to controls. Dermatoglyphics can be used for screening tool for Pulmonary tuberculosis contacts for genetic susceptibility to disease as a cost effective, noninvasive harmless technique.

Study of ATD Angle and Finger Ridge Count in Leprosy Patient of Bhavnagar District.

Introduction: The ATD angle and finger ridge count, are palmar dermatoglyphics features of an individual. During the first & second trimester of pregnancy epidermal growth occur in stages and result in an increase epidermal thickness. Epidermal ridges begin to appear in embryos at 10th week and are permanently established by 17th weeks. The types of pattern develop in palm & soles are genetically determined. They are of considerable clinical interest because they affected by certain anomalies of early development including genetic disease. Objective: There are certain genetic (Chromosomal), Non chromosomal & metabolic disease shows particular palmer dermatoglyphics features so in this study we were trying to find out the difference in dermatoglyphics features in leprosy patient and control group. Materials and Methods: The sample consists of 100 cases of leprosy in age group of 18-60 year from Bhavnagar district. The finger print and palm print were taken by using ink & pad method and Compared with Control group of 18-60 years. The dermatoglyphics parameter like ATD angle, TFRC & AFRC were studied and evaluated for statistical significance. Results and Conclusion: There was statistically significant difference was observed in ATD angle as compared with control. There was no statistically significant difference observed in TFRC & AFRC as compared with control. The dermatoglyphics features can be useful diagnostically to differentiate the leprosy patient and control group.

Anatomical study of nutrient foramina in long bones of human upper limbs.

Background: An opening into the bone shaft for passage of blood vessels to the medullary cavity of a bone for its nourishment and growth is called as nutrient foramen. There is always a need for a greater understanding of nutrient foramina in upper limb bones such as the humerus, radius and ulna. So the aim of present study was to record the location, number and direction of nutrient foramina in long bones of the upper limb. Material and methods: A total number of 120 long bones (40 humeri, 40 radii and 40 ulnae) were used for the study. Results: In the results, 66% of the humeri had a single foramen, 18% had double foramina and 26% had no foramen. For the radii, 68% had a single nutrient foramen and 32% had no nutrient foramen 78% of the ulnae had a single nutrient foramen and 22% had no nutrient foramen. All the foramina except one (in the radius) were directed away from the growing end, that is, they were directed towards the elbow Conclusion: Information and details about nutrient foramina is of clinical importance, especially in surgical procedures like bone grafting and bone transplantation.

Estimation of stature from hand length in living subjects of Gujarat Region.

Background: The hand length can be used as a basis for estimating stature in cases where only fragmentary or mutilated remains of an unknown person are recovered and also in age related loss in stature. Objectives: To investigate the relationship between Personal Stature and Hand Length in living subjects of Gujarat region and derive a population specific formula (regression equation) to estimate Stature from Hand Length. Methods: Height and Hand Lengths were measured of total 510 living subjects (258 males & 252 females) between the age group of 18-25 years belonging to Gujarat Region. Results: A positive correlation was found between Height and Hand Length and it was statistically significant. Regression equation for stature Estimation was formulated using Hand Length in both sexes. Conclusion: Dimensions of Hand can provide good reliability in estimation of stature. Simple linear regression equation so far derived can be used for estimation of height. If either of the measurement (Hand length or Total Height) is known, the other can be calculated. This fact will be of practical use in Medico Legal investigations and in Anthropometry.

The study of cephalic index in living subjects in Gujarat Region.

Background and objectives: The cephalic index exhibits sexual differences and different shapes of head. This information will be highly important for Plastic surgeons, Forensic Scientists, Anatomists, Human Biologists, Criminologists & Physical Anthropologists.Method: The present study was performed on 510 living subjects of Gujarat (243 male and 267 female) of 18 to 30 years in the year of 2011 with the objective to study the sex differences in cephalic index. Cephalic index was investigated with the help of head length and width with the use of spreading caliper.Result: The study showed that mean head length and width were higher in males than in females , while mean cephalic index was higher in females than in males. Interpretation and Conclusion: Predominant head type was mesocephalic in both sexes and there was no significant gender difference (p value > o.o1).

Morphometric study of mental foramina in dentate and edentulous human mandible in Gujarat Region.

Background & Objectives: will be useful for anatomists, anthropologists, aneasthetist, orthopedics and experts in the field of forensic medicine. The aim of the study was to examine the different morphometric variations of the human mandibles and comparing between dentate and edentulous mandibles is done. Methods: This study included only bone who exhibited no obvious bone pathology. All measurements were done bilaterally, performed with a stainless steel metric digital calliper with 0.01 mm precision. The relative position of the Mental foramena (MF)as analyzed with measurements made from nferior wall of mandible to the mandibular base, from anterior wall of mandible to the mandibular skeletal midline, from his posterior wall to the posterior mandibular rim. To determine this relation, the standard horizontal plane defined by Morrant was used. Briefly, the mandible was placed on a horizontal surface, to which the lower border of the mandible comes into greatest contact when vertical pressure is applied to the second molar teeth. Results: The most common location for the MF is a position aligned between second premolar and first molar (Rt. side 30% & Lt. Side 31%). Comparison of measurements of dentate and edentulous mandible is significnat on both sides. Conclusion: The knowledge of the distances from surgically encountered anatomical landmarks in the present study provide valuable information to dental surgeons that will facilitate effective localization of the neurovascular bundle passing through mental foramen thus avoiding complications from local anesthetic, surgical and other invasive procedures.

A study of congenital anomalies in newborn.

Total 4210 babies were studied in the neonatal period immediately after birth, which shows overall 0.88%. incidence of congenital malformations. Incidence was significantly higher (6.1%) in mothers aged > 30 years as compared to younger age group. Religious pattern of mother and consanguinity of marriage had no much effect on the incidence. The incidence was marginally higher in primiparous patients (47.2%). Only in 12% of cases some etiological factors could be found, of which maternal fever in first trimester was the most common. 10 cases with CNS malformations had hydroamnious. The anomaly was detected antenatally in 49%cases with the help of USG. The ration of still birth to live birth was 4.19:1 suggesting that many of the anomalies are incompatible with life. There was no overall difference in the sex of the babies. However most of anencephalic babies were female. Preterm babies had four times more incidence of congenital malformations as compared to term babies. This represents ―phenomenon of nature’s selection‖. Associated hydroamnios also accounts for preterm labour similarly congenital malformations were more commonly found in low birth weight baby. Out of all system involved in congenital mal formation, CNS was the commonest and accounted for 1/3 rd of the cases.

An unusual localization of mucormycosis diagnosed by fine needle aspiration cytology: a case report.

Mucormycosis is an uncommon fungal infection, occurring mainly in patients with acidosis, chronic illnesses and malignancies. The most frequent site of involvement in patients of hematological malignancies is the respiratory tract. Isolated subcutaneous localization of mucormycosis in such patients is extremely rare. We report a case of a young patient of non-Hodgkin's lymphoma on chemotherapy who presented with a subcutaneous swelling on the anterior aspect of right thigh. Fine needle aspiration cytology (FNAC) smears from the swelling revealed numerous characteristic broad, irregularly contoured and pleomorphic hyphae of mucormycosis. This fungus seldom grows in culture and confirmation of the diagnosis depends on cytological or histological examination of infected tissues. Our case report documents a rare site of isolated mucormycosis infection and emphasizes the role of FNAC as a simple, rapid, accurate, and useful method of diagnosing fungal infections.

Role of mitotic counts in the grading and prognosis of the breast cancer.

100 Cases of invasive breast cancer were studied for Tumor type, Tumor site, Nodal Status, Mitotic counts, Nuclear pleomorphism, Tubule formation and Nottingham modification of Bloom Richardson Grading. The follow up of the 82 patients treated with surgery and adjuvant treatment was available. Mitotic activity index (MAI) counted with strict criteria of elston CW, emerged as one of the most significant prognostic parameter followed by overall grade in predicting Tumor free survival (TFS) for the patients. Mitotic count also correlated well with overall Grade and lymph node status in predicting the TFS. This parameter is very useful where advanced studies like flowcytometry and immunohistochemical studies of the cell proliferation marker are not available.