To Identify the Dangerous Length of External Laryngeal Nerve In Relation to Thyroid Pole In Cadaveric Thyroid Glands

Introduction: The external laryngeal nerve passes through the “space of Reeve” cricothyroid space. It has also been described as lying in the Joll’s triangle. It is often inadvertently neglected during thyroid surgeries. It has been named after a singer who lost her voice after a thyroid surgery, as the “nerve of Galli Curci” Aim: To identify the dangerous length of the external laryngeal nerve in relation to the thyroid pole. Material and Methods: Fifty laryngeal nerves were dissected using conventional method of dissection, in twentyfive embalmed cadavers used for teaching purpose at Karpaga Vinayaga Institute of Medical Sciences and Research, Madurantakam. The observations were noted and photographs taken. The course and relations were carefully noted. Results: 38 specimens (76%) had the superior laryngeal nerve measuring 4cm. in 8 specimens (16%) it was 3.5 cm and in 04 specimens (8%) it measured 3.8 cm. It was observed that the external laryngeal nerve crossed the superior thyroid pole at less than 1cm only in three (6%) of the fifty nerves. Conclusions: The critical length of the nerve would be dangerous if the nerve crosses the superior thyroid pedicle close to thyroid pole at less than 1 cm. The consequences of neglecting the critical length would injure the nerve and cause dysphonia or raspy voice.

Estrogen and Progesterone Receptors in Breast Malignancy-Their Expression and Correlation with Histologic Parameters in Southern India

Breast carcinoma is the most common malignancy among South Indian women. Hormone receptor evaluation has become crucial for management of breast cancer. Very few studies have correlated oestrogen receptors (ERs) and progesterone receptors (PRs) with histologic parameters in Andhra Pradesh state of Southern India; therefore, the study was undertaken, and it is also to study the importance of immunohistochemistry (IHC) evaluation of ER and PR status and to evaluate and conclude the importance of modified Bloom-Richardson (MBR) grading in a routine investigation for prognosis and prediction of clinical outcomes. Aims and Objective (1) To evaluate the expression of hormone receptors in breast carcinoma and (2) to correlate their expression with other histological variables. Materials and Methods A prospective study was conducted for 2 years, at a tertiary care hospital in Vijayawada, Andhra Pradesh, India. In our study, 100 consecutive cases were included, which were reported by MBR system and evaluated for ER & PR receptor expression by Allred score. Statistical analysis was done by SPSS software, Student t-test and chi-square test. Results Majority of the age group affected was below 50 years, and mean age of the study population was 46.25 years. The most common histological variant was infiltrating duct cell carcinoma (91%), and predominant histological grade was MBR grade II (47%). ER and PR positivity were noted in 56% and 53% of cases, respectively. The common phenotypic expressions were ER+ PR+ (46%) & ER-PR-(37%). ER positivity was observed in 25% of grade I, 54.54% of grade II and 20.46% of grade III lesions (p = 0.005), and expression of PR was seen in 25.53% of grade I, 51.06% of grade II and 23.54% of grade III lesions (p = 0.001). ER+ PR+ phenotypic expression was positively correlated with low histologic grade, whereas ER-PR-correlated with high histological grade (p = 0.003). ER+ PR+ also correlated with lymphatic spread (p = 0.046) and vascular invasion (p = 0.011). However, no correlation was observed with age, tumour size and ER & PR expression (p > 0.05). Conclusion High nuclear pleomorphism, low tubule formation, high mitotic score & lymphovascular invasion were found more common in ER-PR-group than in ER+ & PR+ group with significant statistical correlation. ER & PR expression showed statistically significant correlation with MBR system and other pathological parameters. Hence, MBR grading should be incorporated as a routine investigation for prognosis and prediction of clinical ou Breast carcinoma (CA), Oestrogen receptor (ER), Immunohistochemistry (IHC), Invasive ductal carcinoma (IDC), Modified Bloom-Richardson grading (MBR), Progesterone receptor (PR) nuclear pleomorphism.

A Rare Case of Tamoxifen-Induced Thrombocytopenia.

Breast cancer is a commonly encountered cancer in women. Tamoxifen is a frequently used drug in breast cancer. It is a selective estrogen receptor modulator (SERM). It is used for both chemoprevention and for palliative care in these patients. Drug-induced thrombocytopenia is a common diagnosis these days. Moreover, this condition can be life threatening or even fatal. It can either be due to increased platelet destruction or reduced formation. Either way, early diagnosis followed by discontinuation of the offending agent is the key to successful management. Here, we present a rare case of tamoxifen-induced thrombocytopenia

Amlodipine -Atenolol Overdose Management: A Physician’s Nightmare.

The author reports a case of a 22-year-old female, daughter of a known hypertensive patient, who happened to consume her mother’s medicine. Her mother was on a fixed drug combination (FDC) of amlodipine and atenolol. The patient was brought to the emergency department with drowsiness following ingestion of 15 tablets of amlodipine-atenolol FDC (5+ 50 mg). On evaluation, she had refractory bradycardia and hypotension along with hyperkalemia. She was managed initially with gastric lavage with activated charcoal, and subsequently with supplementation of atropine, inotropes, anti-hyperkalaemic measures, pacemaker and levosimendan.

Extra Hilar Branching of Renal Arteries: An Anatomical Study.

Introduction: The objective of this study was to observe the patterns of different arteries that supply the kidneys. The kidney has a segmental distribution of arteries. The kidneys are divided into five vascular segments. The arteries that arise from the aorta above or below the main renal artery and reach the hilum are called accessory renal arteries. They are persistent embryonic lateral splanchnic arteries. Accessory renal arteries may arise from the celiac or superior mesenteric arteries, near the bifurcation or from the common iliac arteries. The present study has attempted to find out accessory, and aberrant arteries to kidneys with review of literature. Materials and Methods: The study was done on 52 kidneys randomly selected from cadavers that were used for the purpose of teaching in the department of Anatomy at P.E.S Medical College. The kidneys were removed from the cadavers en-block with the arteries and veins intact. The renal artery was observed for its pattern of branching. Observations and Discussion: The pre-hilar branching pattern was absent only in six kidneys out of the 52 kidneys selected. The branches given before entering the hilum were either in the form of a fork pattern or a ladder pattern in the remaining 46 kidneys. The fork pattern wherein the branches arose from a single point was found in 42 kidneys. The ladder patterns were seen in two posterior segment arteries and two anterior segment arteries. The anterior division often showed the fork patterns which were either duplicate or triplicate outside the hilum more proximally, with further division into duplicate or triplicate terminal branches closer to the hilum but significantly outside.

Amniotic Fluid Optical Density (AFOD) correlates with the lung maturity as well as complete maturity of the fetus A clinical observational study.

According to ACOG committee, complications of non-medically indicated (elective) deliveries between 37 and 39 weeks are faced with increased NICU admissions, transient tachypnea of thenewborn (TTN), respiratory distress syndrome (RDS), increased need for ventilator support, increased sepsis rates (suspected or proven) and higher incidence of newborn feeding problems and other transition issues. Cesarean sections done at less than 39 weeks gestation have increased risk of neonatal morbidity including respitory distress, hypoglycemia, sepsis, NICU admissions, hospitalization for more than 5 days, etc this study aims at correlating fetal maturity with amniotic fluid optic density.

Assessment of cardiovascular hemodynamics in gestational hypertension and preeclampsia.

Preeclampsia is a multisystem disease complicating 5-10% of pregnancies and remains in the top three causes of maternal morbidity and mortality globally. During pregnancy mean arterial pressure and vascular resistance decrease, while blood volume and basal metabolic rate increase resulting in increased cardiac output In hypertensive disorders of pregnancy there is currently no consensus on the systolic and diastolic parameters of cardiac function and the literature is conflicting regarding whether there is increased, decreased or any change in cardiac output. Women with a history of preeclampsia/eclampsia have approximately double the risk of early cardiac, cerebrovascular, and peripheral arterial disease, and cardiovascular mortality. This study was undertaken to evaluate cardiovascular hemodynamic alterations in hypertensive disorders of pregnancy in comparison with appropriately age, parity and gestational age matched control normotensive pregnancies. In women with preeclampsia cardiac work index and left ventricular mass index are increased as a result of increased workload on heart to maintain cardiac output against increased after load. Systolic function is well preserved. Diastolic function is reduced and those with global diastolic function are at increased risk of developing pulmonary edema. Advanced techniques like speckle tracking echocardiography can better identify those with compromised cardiovascular function.

Unusual branching pattern of external carotid artery in the left carotid triangle.

During the routine dissection of the neck for the first MBBS students, we have found the abnormal branching of the external carotid artery in the carotid triangle. The external carotid artery is a terminal branch of the common carotid artery arises at the level of superior border of the thyroid cartilage in the carotid triangle. It supplies the structures of head and neck regions by its eight branches. The knowledge of variations is very important for the general, head & neck, ENT and oncosurgeons, to avoid unforeseen complication in the form of bleeding by injuring the abnormal arteries. It is also important for the vascular surgeons and radiologists while performing the procedures on the arteries.

Brachiocephalic Trunk and Left Common Carotid Artery Arising from Aortic Arch as a Single Trunk.

Branches of aortic arch usually are brachiocephalic trunk, left common carotid artery and left subclavian artery from right to left direction. Arch of aorta show more variations in branching patterns. One among which is origin of only two branches in which brachiocephalic trunk and left common carotid artery arise together as a common trunk and other branch is left subclavian artery. The variations occur due to abnormal development of arch of aorta. During routine dissection of superior mediastinum of thoracic region, we have found the left common carotid artery and brachiocephalic trunk was arising from the arch of aorta as a common trunk. These kinds of variations are very rare and knowledge of which is very important for neck surgeons, cardiologists and interventional radiologists while doing surgeries and instrumentation procedures.

Trifurcation of External Carotid Artery and Variant Branches of First Part of Maxillary Artery.

The external carotid artery normally divides into two terminal branches at the level of the neck of the mandible. The terminal branches are usually the superficial temporal and maxillary arteries. The maxillary artery is described to be in three parts in relation to the lateral pterygoid muscle as the mandibular (first), pterygoid (second) and the pterygopalatine (third) parts. The second part passes behind the muscle. The branches that arise from the first part of the maxillary artery are the deep auricular, anterior tympanic, the middle meningeal, accessory meningeal and inferior alveolar arteries. The middle meningeal artery normally arises at the lower border of lateral pterygoid muscle from the first part of maxillary artery. It then ascends upwards, passes between the two roots of the auriculotemporal nerve and enters the foramen spinosum in the base of skull. During routine dissection of a male cadaver in the department of anatomy while teaching medical students variations were observed in the termination of the external carotid artery on the right side. The artery gave three branches at the termination, superficial temporal, maxillary and between the two the middle meningeal artery was seen arising close to the end of the external carotid artery. The middle meningeal artery did not pass between the two roots of the auriculotemporal nerve. The branches of first part of maxillary artery were variable. The deep auricular branch was absent and its territory may have been supplied by the posterior auricular and anterior auricular arteries. The anterior tympanic and accessory meningeal arteries arose from the middle meningeal artery. There were two inferior alveolar arteries 1.5 cm apart arising from the first part of maxillary artery. The first artery went to the mandibular canal along with the inferior alveolar nerve. The second artery accompanied the lingual nerve to the last molar tooth. Probably this artery may have been an additional supply to the gingiva around the last molar tooth. The other variations that were noted were the absence of mylohyoid branch from the inferior alveolar artery. To the best of our knowledge these variations in the arteries have not been previously reported.

Proliferating trichilemmal tumour: a case report with review of literature.

Proliferating trichilemmal tumour is a solid-cystic neoplasm that shows trichilemmal differentiation similar to that of the isthmus of the hair follicle histologically characteristed by the presence of trichilemmal keratinization. Proliferating Trichilemmal Tumour (PTT) appears mainly in elderly women and is in general a solitary lesion on the scalp. Proliferating trichilemmal tumours generally have a benign clinical course, and a clinical differentiation from squamous cell carcinoma is often difficult. We report a case of PTT in a 30 year old man presenting as a solitary 10x8 cm ulcerated nodule on the scalp since 3 months clinically resembled a malignant tumour. The therapeutic approach is surgical removal with a wide clear margin.

Strongyloides Hyperinfection in Renal Transplant - diagnosis by Endoscopic Intestinal Biopsy.

Introduction: Intestinal parasites continue to be a significant health problem in renal transplantation patients. Strongyloides infection is unique that it excretes larvae and can continue life cycle by auto infective cycle also. Presentation of the case: We present a 26 years old man presented with acute cellular rejection after three months of kidney transplantation. Before transplantation stool of both recipient and donor was negative for parasites. He received three doses of intravenous methylprednisolone. After one month he presented with severe epigastric pain and vomiting. On examination he was malnourished, dehydrated and lost two kilograms of weight over one month. His serum albumin was 2.9 mg/dL. Pain did not subside with proton pump inhibitors. Stool examination was negative for parasites. As index of suspicion for parasites was high, upper GI endoscopy was done; it showed multiple ulcers in duodenum. Biopsy of the ulcer showed strongyloides infection He was treated with ivermectin. Abdomen Pain was subsided soon. He gained weight of 1.5 kilograms over next month. Conclusion: When transplant patients from developing country with recent increase of immunosupression presents with severe abdomen pain, the intestinal parasitic infection should be entertained. If stool examination is negative and serology is unavailable, early evaluation by endoscopic biopsy is helpful to diagnose strongyloides. Prolonged treatment with ivermectin and follow-up stool examinations are important for complete cure of strongyloides infection.

In–Vitro Anthelmintic Activity of Pet – Ether Extract of Portulaca Oleracea (LINN.) Against Pheritima Posthuma.

Present study was carried out to investigate the anthelmintic potential of petroleum-ether extract of Portulaca oleracea against Pheretima posthuma as a species of earthworm. Various concentrations (25‐100 mg/ml) of petroleum-ether extract were evaluated for anthelmintic activity by recording the time required for paralysis and death of worms. Albendazole was used as standard. Result indicates that petroleum-ether extract significantly (p<0.01) exhibited paralysis at lower doses of 50, 75 and 100 mg/ml and causes death of worms at doses of concentrations 75 and 100 mg/ml when compared with standard. The present study indicates that the petroleum-ether extract of Portulaca oleracea has a potential anthelmintic activity can be used as anthelmintic drug.

Synthesis of quinolines and their In vitro antioxidant activities under solvent free conditions by using the SiO2-Zn-MgO as a novel and reusable catalyst.

The present study was aimed to determine a novel route of synthesis of quinolines and their in vitro antioxidant activities. Synthesis of quinolines is simple, economic, effective and an easy way process has been developed by using the SiO2–Zn-MgO as a novel catalyst. The quinolines antioxidative potential was evaluated using 1,1-Diphenyi-2-Picrylhydrazyl (DPPH), superoxide radical, hydroxyl radical, and hydrogen peroxide radical assay by in vitro methods. Quinolines exhibited highest level of antioxidant activities, and therefore it could be used as antioxidant that may have potential benefits in health and disease management.

Design and development of levofloxacin hemihydrate fast dissolving tablets using fenugreek powder.

Levofloxacin hemihydrate is an antibiotic used for bacterial infections. It belongs to flouroquinolones class. Fast dissolving tablets gaining popularity over conventional tablets due to their convenience in administration and suitability for patients like geriatrics and pediatric patients because of their swallowing difficulties. The half-life of the drug is 6-8 hrs and it is rapidly and completely absorbed after oral use for that levofloxacin prepared as fast dissolving tablets. Tablets were prepared by direct compression technique by using MCC as binder. Super disintegrants used are SSG(2%,3%,4% and 5%),CCS(AC-DI-SOL) (2%,3%,4%and 5%), CP(2%,3%,4%and5%)and FGP(2%,3%,4%and 5%),.Among these 4 super disintegrants, Fenugreek powder (FGP) was show best results in the evaluation tests.

Evaluation of anti arthritic activity of pet – ether extract of portulaca oleracea (Linn.).

To investigate the antiarrthritic activity of petroleum-ether extract of Portulaca oleracea. The petroleum-ether extract of Portulaca oleracea was subjected to preliminary phytochemical screening. Acute toxicity studies were carried out in Male Wistar rats and anti-arthritic activity by Fruends adjuant arthritis model. Phytochemical evaluation revealed the presence of alkaloids, tannins, flavonoids, saponins and triterpenoids. Acute toxicity studies showed that the extract was non-toxic upto a maximum dose of 2000 mg/kg body weight. Petroleum-ether extract exhibited significant anti-arthritic activity. The present study indicates that the petroleumether extract of Portulaca oleracea has a potential anti-arthritic activity can be used as anti-arthritic drug.

Design and in vitro evaluation of effervescent gastric floating drug delivery systems of propanolol HCl / Diseño y evaluación in vitro de sistemas de administración de tabletas flotantes gástricas everfescentes de HCl propanolol

The purpose of this research was to develop and evaluate effervescent gastric floating tablets of propranolol HCl. The oral delivery of antihypertensive propranolol HCl was facilitated by preparing an effervescent floating dosage form which could increase its absorption in the stomach by increasing the drug’s gastric residence time. In the present work, effervescent floating tablets were prepared with a hydrophilic carrier such as polyethylene oxide (PEO WSR N 60K and PEO WSR 303) as a release retarding agent and sodium bicarbonate as a gas generating agent. The prepared tablets were evaluated for all their physicochemical properties, in vitro buoyancy, drug release and rate order kinetics. From the results, P9 was selected as an optimized formulation based on their 12 h drug release, minimal floating lag time and maximum total floating time. The optimized formulation followed first order rate kinetics with erosion mechanism. The optimized formulation was characterized with FTIR studies and no interaction between the drug and the polymers were observed.

El propósito de la presente investigación fue desarrollar y evaluar tabletas flotantes, efervescentes de HCL propranolol. La administración oral del antihipertensivo HCL propranolol se facilitó mediante la preparación de una forma de dosificación flotante y efervescente que permitiría su absorción en el estómago, mediante el aumento del tiempo de residencia gástrico de la droga. En el presente trabajo, las tabletas flotantes efervescentes fueron preparadas con un portador hidrofílico, tal como el óxido de polietileno (PEO WSR N 60K and PEO WSR 303), como agente retardador y bicarbonato de sodio como un agente generador de gas. Se evaluaron todas las propiedades fisicoquímicas de las tabletas preparadas, su flotación in vitro y su tasa de orden cinético. Se seleccionó el P9 a partir de los resultados obtenidos, como una fórmula óptima, basados en la liberación de la droga a las 12 h, tiempo mínimo de retraso para flotación y máximo tiempo total de flotación. La formulación optimizada siguió una tasa cinética de primer orden con mecanismo de erosión. Esta fórmula óptima se caracterizó mediante estudios FITR y no se observó ninguna interacción entre la droga y los polímeros utilizados.

Formulation and evaluation of fast dissolving tablets of Granisetron hydrochloride by vacuum drying technique.

The purpose of this investigation was to develop fast dissolving tablets (FDTs) of Granisetron hydrochloride (GHCl) by vacuum drying technique using camphor as subliming agent together with croscarmellose sodium (CCS), crospovidone (CP), sodium starch glycolate (SSG) and plantago ovate (PO) as superdisintegrants. The prepared formulations were evaluated for pre-compressional and post-compressional parameters. The compatibility of drug with other ingredients was checked by FTIR studies, the results revealed that there was no interaction between dug and other excipients. The values of pre-compressional parameters were within prescribed limits and indicated good free flowing properties. In all the formulations the hardness test indicates good mechanical strength. Friability of all formulations was less than 1. Drug content was found to be high (≥ 100.44%) and uniform in all the formulations. The tablet thickness was found to be 3.11 – 3.34. The weight variation results revealed that average percentage deviation was less then ± 7.5 %, which provides good uniformity in all formulations. The disintegration time of the tablets found to be in the range of 18 to 44 sec. The formulations SBC4, SBP4, SBG4, and SBO4 50 % of drug released in 0.41, 0.48, 0.59 and 0.47 min, and 90 % of drug released in 2.01, 3.05, 4.01 and 2.51min. Stability study carried out as per ICH guidelines for three months and results revealed that upon storage disintegration time of tablets decreased significantly (p<0.05). The release of drug from the SBC4 and SBO4 formulations was quick when compared to other formulations. It was concluded that fast dissolving tablets with improved Granisetron hydrochloride dissolution could be prepared by sublimation of tablets containing suitable subliming agent.

Formulation and evaluation of fast dissolving tablets of granisetron hydrochloride.

Fast dissolving drug delivery systems offers a solution for those patients having difficulty in swallowing tablets/capsules etc. Granisetron hydrochloride was selected as the model drug. In the present study, an attempt had been made to prepare fast dissolving tablets of the drug using , plantago ovata mucilage and sodium starch glycolate as super disintegrants (2.5 to 10 % w/w) following by direct compression method. Formulations were evaluated for precompressional parameters such as angle of repose, carr’s compressibility index and hausner’s ratio. The tablets were evaluated for uniformity of weight, thickness, hardness, friability, drug content, wetting time, in-vitro dispersion time and in-vitro dissolution study. The prepared tablets were characterized by FTIR studies. No chemical interaction between drug and exciepients was confirmed by FTIR studies.