Sexual dimorphism and geographical variance: their impact on the reliability of the antilingula as a landmark in human mandibular surgery.

The intraoral vertical ramus osteotomy (IVRO) is an orthognathic procedure that is used to correct dentofacial abnormalities, and is performed by approaching the lateral aspect of the mandibular ramus. This approach, however, precludes visualisation of the inferior alveolar nerve (IAN) on the medial side, thereby placing it at risk of iatrogenic damage. The antilingula, a bony prominence on the lateral mandibular ramus, has been proposed as a landmark for prediction of the IAN's location during IVRO. The current study aimed to evaluate the variation in incidence and position of the antilingula, and therefore to determine its suitability as a surgical landmark during IVRO. The study included 480 dry hemimandibles from eight geographical populations from the Duckworth Collection in Cambridge. Skulls were sexed by visual analysis of dimorphic traits. Positional relations were determined through the digitisation of nine anatomical landmarks. The antilingula was identified in all specimens. No significant difference was identified in the positional relation between the antilingula and mandibular foramen between sexes, but multiple differences were identified in this relation between geographical populations. Our data showed that, irrespective of geographical variation, an osteotomy performed 8mm posterior to the antilingula would avoid the mandibular foramen in 98.8% of cases.

Intrauterine Exposure to Biologics in Inflammatory Autoimmune Diseases: A Systematic Review.

BACKGROUND: Inflammatory autoimmune diseases are chronic diseases that often affect women of childbearing age. Therefore, detailed knowledge of the safety profile of medications used for management of inflammatory autoimmune diseases during pregnancy is important. However, in many cases the potential harmful effects of medications (especially biologics) during pregnancy (and lactation) on mother and child have not been fully identified. OBJECTIVE: Our aim was to update the data on the occurrence of miscarriages and (major) congenital malformations when using biologics during pregnancy based on newly published articles. Additionally, we selected several different secondary outcomes that may be of interest for clinicians, especially information on adverse events in the use of a specific biologic during pregnancy. MATERIAL AND METHODS: A search was conducted from 1 January 2015 until 4 July 2019 in Embase.com, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar with specific search terms for each database. Selection of publications was based on title/abstract and followed by full text (double blinded, two researchers). An overview was made based on outcomes of interest. References of the included publications were reviewed to include and minimize the missing publications. RESULTS: A total of 143 publications were included. The total number of cases ranged from nine for canakinumab to 4276 for infliximab. The rates of miscarriages and major congenital malformations did not show relevant differences from those rates in the general population. CONCLUSION: Despite limitations to our study, no major safety issues were reported and no trend could be identified in the reported malformations.

Obstructive infertility: changes in the histology of different regions of the epididymis and morphology of spermatozoa.

In the present study, the effects of prolonged obstruction in different regions of the human epididymis on its histology and on the spermatozoa retained at the site of obstruction were assessed. Men who were confirmed of having obstruction of the epididymis underwent vasoepididymostomy (VEA) for surgical correction of the obstruction. At the time of surgery, fluid from the epididymal tubule above the site of obstruction was aspirated and examined for sperm profile. Epididymal tissue, collected at the site of obstruction, was processed for assessment of histological changes and also used to identify the site of obstruction. Prolonged obstruction of the epididymis has caused degeneration of the epididymal epithelium, gradual decrease in the diameter of the tubule and tubular lumen and increase in the intertubular connective tissue. Sperm aspirated from the caput epididymal fluid showed sluggish pattern of motility only in one out of the six subjects, whereas spermatozoa collected from the cauda epididymal fluid showed rapid linear progressive motility in one of three subjects. A major percentage of spermatozoa in the aspirated fluid showed various types of morphological abnormalities, irrespective of the site of obstruction. These results are discussed in relation to the role of the epididymis in investing spermatozoa with motility and fertilizing capacity.

Psychological disturbance among 5- to 8-year-old school children: a study from India.

This paper presents findings on the prevalence of psychological disturbance among a sample of 5- to 8-year-old Indian school children. The study was cross-sectional with a two-instrument, two-phase design. In the first phase (screening), 48 teachers rated 1535 children (810 boys and 725 girls) drawn from five schools in Bangalore city on the 26-item Children's Behaviour Questionnaire (CBQ). This resulted in 281 children being identified as disturbed, giving a prevalence of 18.3%. In the second phase, 279 of the children identified as disturbed on the CBQ and a matched group of 272 'non-disturbed children' (182 boys and 90 girls) were again rated by teachers, this time using the Child Behaviour Checklist--Teacher Report Form, yielding a corrected prevalence rate of 19.8%. In the same phase, 166 of the disturbed children and a matched group of 169 non-disturbed children were rated by parents using the Child Behaviour Checklist, yielding a corrected prevalence rate of 31.7%. A larger proportion of boys than girls were identified as disturbed by teachers, whereas parents identified a large proportion of disturbed girls. Boys were found to manifest externalizing problems more often, while girls more frequently showed internalizing problems. Learning problems were identified in a substantial number of disturbed boys and girls.

The role of estimation of the ratio of preoperative serum thyroglobulin to the thyroid mass in predicting the behaviour of well differentiated thyroid cancers.

Although serum thyroglobulin (STg) is a useful tumour marker to detect the recurrence of tumour in well differentiated thyroid carcinoma, it has as yet not been reported to be of value in predicting the behaviour of thyroid cancer. In the present study of 20 patients, the measurement of preoperative Stg/thyroid mass has been utilised to find out Tg synthesizing capacity of the tumour. This ratio was significantly higher in the patients with follicular variety than in papillary thyroid carcinoma. It was significantly higher in the metastasis group than in the group of patients without metastasis. The patients with functioning metastasis had a higher than average value of this 'ratio' than those with non functioning metastasis, though the difference was not statistically significant. Despite the limitation of a small number of patients included in this study, it is possible to highlight the possible utility of preoperative Stg estimation as a tumour marker in categorization of the patients of carcinoma of the thyroid gland.

Prevalence of scholastic backwardness among five to eight year old children.

The present paper reports the findings of a study of scholastic backwardness among five to eight year old school going children. 1535 children were screened by their class teachers, of which 10.23% were found to have scholastic backwardness. No gender differences were noticed. The rates of specific difficulties such as reading, writing and arithmetic were found to be 4.69%, 5.15% and 15.96% respectively. About 26% of the scholastically backward children were also found to have psychological disturbance. In addition, they most often came from families which could not afford basic amenities, had fathers with alcohol dependence, inconsistent disciplining and poor parental interaction. They also had more frequent school changes, tution attendence and fewer hobbies compared to the scholastically superior children.

Incidence of Nelson's syndrome and residual adrenocortical function in patients of Cushing's disease after bilateral adrenalectomy.

Eighteen patients of Cushing's Disease, who had undergone bilateral "total" adrenalectomy 2 to 10 years back, were evaluated for residual adrenocortical function and for any evidence of Nelson's Syndrome. Surprisingly, all patients were discovered to have measurable plasma cortisol, albeit in the subnormal range. The standard criteria for accepting "completeness of adrenalectomy" were fulfilled in 16 patients. It was possible to wean one patient off replacement therapy. Thus, the dose of replacement steroids needs to be regulated according to the blood steroid levels in order to avoid unnecessary hypercortisolism. Radiological evidence of pituitary tumor diagnosed Nelson's Syndrome in 2 patients. Nelson's Syndrome was further suspected in 8 others who showed pigmentation. One of these had an enlarged sella and an erosion of the dorsum sellae, but had a normal CT scan. Another patient had evidence of incidental pituitary pathology (incidentaloma) which resolved spontaneously. Contrast enhanced CT scans of the sella are necessary for early detection of Nelson's Syndrome.

Ultrastructural changes in the efferent duct and epididymis of men with obstructive infertility.

Ultrastructural changes in the efferent duct and in different regions of the epididymis in men with obstructive azoospermia were compared with corresponding tissues collected from men of proven fertility who underwent castration due to malignancy of the prostate. Major degenerative changes were seen in the efferent duct and the caput epididymidis of men with obstruction at the caput epididymidis which may have been induced by fluid pressure due to defective absorption of testicular fluid in the caput epididymidis. These degenerative changes included decrease in tubular and lumen diameter of the caput and the cauda epididymides, decrease in height of the stereocilia, reduction in rough endoplasmic reticulum and Golgi material, and presence of lipofuscin and osmiophilic dense bodies. The degenerative changes were less when the site of obstruction was in the cauda epididymidis since fluid reabsorption would continue to take place normally in the caput epididymidis. In men who had undergone vasoepididymostomy (VEA), the ejaculated spermatozoa showed a high percentage of morphological abnormalities which may have occurred due to adverse effects of long-term obstruction on spermatogenesis.

Studies on some biochemical characteristics of Staphylococcus aureus of buffalo mammary origin.

A total of 49 isolates of Staphylococcus aureus of buffalo mammary origin were studied for biochemical characteristics. Coagulase production, clumping factor, haemolytic activity, pigment production and fermentation of maltose and mannitol were employed to differentiate S. aureus from S. hyicus and S. intermedius. Out of 49 isolates, 97.95, 93.87, 93.87, 89.79, 95.91, 100.0, 95.91, 59.18, 100.0, 100.0, 100.0, 89.79, 91.83 and 100.0% isolates were positive for coagulase production, protein-A production, haemolysin production, thermostable nuclease production, deoxyribonuclease production, tellurite reduction, nitrate reduction, lipase production, phosphatase production, mannitol fermentation, glucose fermentation, M.R. test, V.P. test and pigment production respectively. The only isolate from which coagulase production could not be detected, however, showed haemolytic activity, protein-A productivity, pigmentation and mannitol fermentation. One of the protein-A negative isolate was coagulase positive and showed mannitol fermentation, pigmentation and haemolytic activity. The study revealed that the biochemical characteristics of S. aureus of buffalo mammary origin did not differ from those of cattle origin. Coagulase, haemolysin, thermostable nuclease, deoxyribonuclease, phosphatase, lipase, tellurite and nitrate reduction closely related with protein-A. The presence of protein-A seems to be as reliable an indicator for S. aureus of buffalo origin as is coagulase production.

Paraplegia due to osteitis fibrosa secondary to primary hyperparathyroidism: report of a case.

A case of primary hyperparathyroidism associated with osteitis fibrosa cystica presenting as paraplegia is described herein. The symptom complex of normocalcemic hyperparathyroidism with osteitis fibrosa cystica is a distinctly rare entity and to the best of our knowledge, this is the first case report of the normocalcemic variant of primary hyperparathyroidism presenting with paraplegia as a complication.

Serum and semen levels of immunoreactive prolactin, LH and FSH in normospermic, oligospermic and azoospermic men with obstructive infertility prior to and after vasoepididymostomy.

Attempts were made to validate RIA for prolactin (PRL), LH and FSH in semen from normospermic, oligospermic and azoospermic subjects. The RIA used to measure PRL and LH in semen fulfilled the criteria of reliability, whereas low levels of FSH in semen precluded the validation of FSH assay in semen. Semen levels of PRL and LH were significantly (P < 0.05) higher than serum levels in all groups of subjects investigated. Semen levels of FSH in azoospermic men after vasoepididymostomy (VEA), were significantly (P < 0.05) higher compared to azoospermic men prior to surgery. Serum levels of PRL were significantly higher (P < 0.05) in normospermic men compared to oligospermic and azoospermic men prior to and after surgery. Semen levels of PRL in normospermic men were comparable with oligospermic and azoospermic subjects prior to and after surgery. Serum levels of LH in oligospermic and azoospermic men who did not undergo surgery and in men reporting oligospermia after VEA were comparable to normospermic subjects but in men showing azoospermia post surgically, serum LH levels were significantly (P < 0.005) elevated. Semen levels of LH in men reporting azoospermia before surgery and in subjects showing oligospermia or azoospermia post surgically were significantly lower (P < 0.05) compared to men with normal sperm count. Serum levels of FSH were significantly elevated (P < 0.05) compared to semen levels in oligospermic men prior to surgery but this increase was not seen in post VEA subjects. These results were discussed.

A screening tool for assessment of the home environment and psychosocial development of preschool children.

The purpose of this study was to develop a short tool for the assessment of home environment and psychosocial development of preschool children, based on the data collected on a sample of one hundred and fifty children in the age range of 2 years 10 months to 3 years 8 months. Co-relation analysis was used in identifying home environment and psychosocial development variables for the development of the tool.

Epidemiological evaluation of oral polio vaccine efficacy in Delhi.

Forty seven cases of poliomyelitis and 94 controls were studied for immunization status. Unmatched analysis with one control per case and two controls per case was done to find out the ratio of the odds of immunization in diseased individuals as compared with the nondiseased (odds ratio). This ratio (OR) was used further to calculate oral polio vaccine efficacy. OPV efficacy was found to be 93% with 95% confidence limits of 75-98%.

Steroid metabolism by germ cells and spermatozoa in men after vasoepididymostomy.

The ability of germ cells (spermatocytes and spermatids) and spermatozoa present in human ejaculate to metabolize steroids was studied in men with obstructive infertility who had undergone vasoepididymostomy as corrective surgery. Steroid metabolism by spermatozoa in men who had undergone vasovasostomy was also investigated. Germ cells converted testosterone mainly to androstenedione. In addition to androstenedione, dihydrotestosterone and androstanediols were also formed in incubations using spermatids. Both types of germ cells converted estradiol to estrone. Spermatozoa from subjects who had undergone vasoepididymostomy or vasovasostomy converted testosterone to androstenedione as in normal men, while spermatozoa from infertile subjects converted testosterone mainly to dihydrotestosterone. Seminal fluid, free of germ cells, did not show steroid-metabolizing capability.

PIP: Metabolism of testosterone and estradiol by primary spermatocytes, spermatids and spermatozoa of 6 fertile men, 6 men infertile due to immobile sperm, 8 men who had vasovasostomy, and 11 men who had vasoepididymostomy because of obstruction, was studies by thin layer chromatography. Germ cells were collected at 3-month intervals after surgery, and separated by Percoll gradients. Results were reported as percentages of total counts in substrates and products. Germ cells of normal and post-operative subjects converted testosterone primarily to androstenedione, and their spermatids also formed dihydrotestosterone and androstanediols. Spermatozoa and spermatids also formed estrone from estradiol. Spermatozoa from infertile men primarily produced dihydrotestosterone from testosterone.

Hypersensitivity responses to Staphylococcus aureus infections in rabbits. An experimental study.

Repeated weekly infections with S aureus, of bovine mammary origin, for three times evoked an immediate and a delayed type hypersensitivity in rabbits. The skin responses at 6 hr were characterized by oedema, haemorrhages and infiltration of polymorphonuclear cells. While at 24 hr it was dominated by mononuclear cells specially lymphocytes in the dermis.

Histology of the epididymis in men with obstructive infertility.

The histology of different regions of human epididymis in men undergoing vasoepididymostomy to correct epididymal obstruction was studied. The data indicate major degenerative changes in intertubular connective tissue and in the epididymal epithelium. These include increase in connective tissue thickness and its infiltration by leucocytes in some cases, decrease in tubular diameter, degeneration and/or vacuolation of cytoplasm of nonciliated cells of efferent duct and principal cells of epididymis and presence of multinucleate giant cells in the epididymal lumen. These histological abnormalities are discussed in relation to the role such epididymis can play in sperm maturation following vasoepididymostomy.

Fine needle aspiration cytology as a preliminary diagnostic procedure for asymptomatic cervical lymphadenopathy.

Fine needle aspiration cytology (FNAC) was used as a preliminary diagnostic procedure in evaluating discrete, asymptomatic cervical lymphadenopathy of more than four weeks duration. Benign pathologies were encountered in 294/359 patients (82%); of these 86% had tuberculosis. Even in the elderly, a large number of patients (25/78) harboured tubercular lymph glands. FNAC obtained adequate material for cytologic diagnosis in 97.5% and had an overall accuracy rate of 97%. Malignancy was correctly diagnosed in 100%; in tuberculosis the accuracy rate of 96% with a 3.5% false negative results. FNAC is reliable as the initial evaluating procedure even in benign disorders; it is also cheap, speedy and easy to perform, with no complications, making it suitable for wider application in developing countries with scant resources.

Thyroid carcinoma. A report of 206 cases from an area with endemic goitre.

A retrospective analysis of 206 cases of thyroid carcinoma treated at a single surgical service in a region with endemic goitre is presented. In contrast to the marked female preponderance in surgically treated benign thyroid disorders, the frequency of thyroid carcinoma was almost equal in the two sexes (males/females = 100/106). The duration of symptoms was, as a rule, short and there was a predominance of advanced lesions (T3N3M1) even among the well-differentiated tumours. Papillary carcinoma was the most common histologic type (45%) but its proportion was considerably lower than usually reported from non-endemic regions. The average TSH level was significantly elevated in the carcinoma group and associated adenomatous changes were found in 40/100 cases which might suggest an etiologic role of increased TSH stimulation. Since most thyroid carcinomas had a very malignant clinical behaviour, surgical treatment aimed at near-total thyroidectomy which was performed in 62% of the cases. During a follow-up of up to eleven years recurrence in the remaining contralateral lobe occurred in 23% of patients with hemithyroidectomy and loco-regional recurrence was seen in 29% of patients with near-total thyroidectomy. Mortality was high in all histologic types, further underlining the aggressive biologic behaviour of thyroid cancers in an endemic area.

Non-occlusive ischaemic enteritis.

Non-occlusive infarction of the intestine without any associated medical disorder responsible for prolonged hypotension, is a rare clinical entity. A retrospective analysis of 46 cases revealed that the disease occurred predominantly in young, healthy, male patients. The classical presentation was of abdominal pain and persistent tachycardia out of proportion to the abdominal signs of distension, mild tenderness and reduced bowel sounds. The presenting features were of peritonitis due to perforation (63%) and intestinal obstruction (37%). A preoperative diagnosis was suspected only in six cases. Operative findings revealed that the bowel was infarcted without involvement of the mesenteric vessels, which were pulsatile up to the bowel wall. The characteristic findings of the disease, which mainly affected the jejunum (69.6%), were: (i) infarcted area of the bowel surrounded by skip lesions of purple, constriction bands; (ii) multiple small perforations in a paper-thin bowel: or (iii) a long linear perforation. Histologically, ischaemic changes were found to affect the mucosa and submucosa beyond the macroscopic limits. Mortality was high (19.6%).

Prognostic factors in the surgical treatment of azoospermia.

Surgery for male obstructive infertility is not always successful. A number of clinical and operative findings, not previously reported, may influence the outcome. We have studied 182 patients with azoospermia who underwent vasoepididymostomy. The pre-operative and operative findings which adversely affected the function of the anastomosis were identified. The presence of spermatozoa in the semen sample was taken to mean a successful anastomosis. Abnormal testicular histology was an adverse pre-operative finding. Adverse operative findings included non-canalisation of the epididymal tubules and hypoplasia of the epididymis; both factors were associated with a high failure rate (almost 100%). The anastomosis was a failure in 78% of the patients when no fluid was seen on sectioning the epididymis. In the absence of adverse findings the success rate of vasoepididymostomy was 59%. Pre-operative testicular biopsy, together with careful observation and recording of findings before and during surgery, are recommended to avoid needless exploration and anastomosis.