Weight and measurements of kidneys in northwest Indian adults.

Weights and measurements of paired kidneys obtained from medicolegal autopsies of northwest Indian adults, 155 males and 84 females, were compared. The right and left kidneys weighed 108.7 +/- 22.6 g and 111.8 +/- 23.3 g (P > 0.05), respectively, in males. Corresponding weights in females were 96.6 +/- 19.3 g and 99.4 +/- 25.3 g (P > 0.05) for the right and left kidneys, respectively. Sex differences in the weights of both right and left kidneys were statistically significant (P < 0.001). Other measurements of the right kidney in males were as follows: length, 99.5 +/- 9.4 mm; width at the middle of the hilum, 45.8 +/- 6.2 mm; and the thickness 33.3 +/- 5.2 mm, which did not differ from corresponding measurements of the left kidney (99.7 +/- 10.9 mm, 46.4 +/- 7.1 mm, and 34.0 +/- 6.4 mm, respectively). Other measurements of the right kidney in females were as follows: length, 91.3 +/- 8.7 mm; width at the middle of the hilum, 44.6 +/- 4.6 mm; and thickness 31.2 +/- 4.7 mm, which did not differ from those of the left kidney (92.1 +/- 11.0 mm, 43.5 +/- 6.5 mm, and 31.1 +/- 6.1 mm, respectively). Sex differences in measurements of both right and left kidneys were significant except for the width of the kidney at the middle and below the hilum.

An Indian mummy: a case report.

A case of mummification occurring in northwest India (Chandigarh) is described. A middle-aged man developed an abscess on his back and was treated by a mystical man who did not allow him any food or water. After a few days the patient died. On the advice of the mystical man the body was kept in a room which was made hot and dry. The police discovered the body after 2 years. A postmortem examination was conducted and findings are reported.

Gross anatomy of the pancreatic ducts in north Indians.

Gross anatomy of the pancreatic ducts was studied in dissections and by preparing corrosion casts of pancreases, obtained from 218 male and 57 female adult cadavers. In addition 72 normal pancreatograms were also examined. The main pancreatic duct (MPD) started as two or more tributaries in the tail of the pancreas and crossed the body of the 12th dorsal or the first lumbar vertebra or in between in 72.5% males and 62.5% females. In 96% specimens MPD followed the usual course and opened at the major duodenal papilla. Twenty to thirty five lobular ducts opened on either side of the MPD while a few opened on the anterior or posterior walls. There was no 'herringbone' arrangement. The distance between the two ductules varied from 1 to 10 mm. Mode of formation of the accessory pancreatic duct (APD), its course and termination were also studied. In dissected specimens the embryonic type of pancreatic duct (pancreas divisum) was seen in 9 (4.5%) male and 3 (6%) female specimens. In 15.1% male and 26.3% female (p < 0.05) subjects APD will not act as a safety valve if an obstruction occurs in the distal part of MPD.

Dimensions & shape of the trachea in the neonates, children & adults in northwest India.

Measurements of the trachea and the two main bronchi including the subcarinal angle and the angles of the bronchi with the vertical were taken in specimens obtained from 370 adults, 60 children and adolescents up to 17 yr and 27 dead newborns. These measurements showed a gradual increase with age up to a certain point (often 31-35 yr in males and 26-30 yr in females) and stabilised thereafter. There was no sexual dimorphism in measurements till the age of 17 yr and thereafter, the measurements were greater in males than in females (P < 0.001). In adults the body weight and supine body length had a significant correlation with certain measurements of the trachea. The subcarinal angle and the angles of the two main bronchi with the vertical were variable but the angle of the right bronchus with the vertical was always found to be smaller than that of the left. The incidence of different shapes of the trachea at transversely cut upper end was also studied. A U-shaped trachea was present in 33.2 per cent male adults but was not seen in females. This may have some medico-legal importance.

Time of fusion of the basisphenoid with the basilar part of the occipital bone in northwest Indian subjects.

To find out the time of fusion of the basisphenoid with the basilar part of the occipital bone in Northwest Indian subjects, a quadrilateral piece of bone extending from the posterior clinoid processes to the jugular tubercles was removed from 50 male and 34 female autopsy subjects between the ages of 10 and 20 years. The piece of bone was X-rayed and then macerated. In addition CT scan cuts of the basisphenoid were obtained in 46 male and 27 female living subjects between the age of 10 and 19 years. In the males, partial fusion was seen at 13 years while a complete fusion was noticed at 15 years in 25% of the subjects. The age of a boy showing complete fusion should be 15 years or above. If there is no fusion or partial fusion he should be below 19 years as complete fusion is seen in all male subjects at 19 years. In females, the earliest partial fusion was noted at 12 years and complete fusion was present at 13 years in 16.6%. All female subjects showed complete fusion at 17 years. The minimum age of a girl showing complete fusion should be 13 years; if no fusion or partial fusion is seen, her age should be below 17 years.

Incidence and structure of the appendices of the testis and epididymis.

In paired tests obtained from 425 adults, 50 children and 10 neonates, the incidence of testicular appendices was 76% in adults (93.3% sessile) and 83.3% in neonates/children (88% sessile). An epididymal appendix was present in 21.9% of adults and 20% of neonates/children, out of which 79% were stalked in both types of specimen. Three sessile testicular appendices and 11 epididymal appendices were double. The microscopic structure of the appendices and the ultrastructure of their epithelia are described. Testicular or epididymal appendices were not present in any domestic or laboratory animal examined except the horse.

Aluminum phosphide ingestion--a clinico-pathologic study.

BACKGROUND: Aluminum phosphide is widely used in India as a fumigant to protect stored grain from pests and rodents. It is marketed in India as 3 g tablets under several brand names as Celphos, Phostek, Quickphos, and Phosphume. If ingested, it is acutely toxic with a high mortality. The present study was undertaken to define any factors which could predict the outcome after an ingestion. METHODS: Between March 1989 and March 1994, 195 patients with aluminum phosphide ingestion were admitted to Nehru Hospital of the Postgraduate Institute of Medical Education and Research, Chandigarh in Northwest India. The information regarding demography, time elapsed between ingestion and arrival in the hospital, nature of ingestion, dose ingested, symptoms and signs at admission and course during hospital stay was recorded on a proforma. RESULTS: Of 195 patients, 115 died. The deaths could be related to the dose ingested but not to the time elapsed between ingestion and arrival at the hospital. The nonsurvivors had more severe hypotension and metabolic acidosis than the survivors who had more severe vomiting. Autopsies conducted in 115 subjects revealed congestion of liver, spleen, kidneys, adrenals, gastrointestinal tract and brain that correlated with the severity of hypotension. Histopathology did not reveal any specific changes beyond visceral congestion and patchy necrosis of the liver. CONCLUSION: Aluminum phosphide when ingested is highly toxic with fatal dose as low as 1.5 g. The dominant clinical feature is severe hypotension refractory to dopamine.

Time of fusion of epiphyses at the elbow and wrist joints in girls of northwest India.

A radiological examination of both elbows and wrists of 149 Northwest Indian schoolgirls between the ages of 11 and 19 years, of middle socio-economic status, was undertaken to determine the time of fusion of the epiphyses with the metaphyses of the medial epicondyle of the humerus, the proximal end of the radius and the distal ends of both radius and ulna. The data were subjected to discriminant function tests as well as sensitivity and specificity tests. If the epiphysis of the medial epicondyle of the humerus or that of the head of the radius has not fused with metaphysis completely, the age of the girl would be < 16 years. However, the age of the girl should be > 16 years if the distal epiphyses of the radius and the ulna show complete fusion with their respective metaphyses. Discriminant function tests show that 91.95% of girls can be correctly classified as being above or below the age of 16 years.

Incidence of myocardial bridges in northwest Indians.

Dissection of hearts obtained at autopsy from 150 adults (110 males, 40 females) and 15 children (10 males, 5 females) showed an incidence of myocardial bridges over the coronary arteries to be 34.5% in the male and 32.5% in female adults (p = NS); in children the incidence was 40% in either sex. A similar incidence was found in the neonates. Such bridges were also present in the fetuses. A bridge over the anterior interventricular artery could be identified as early as 60mm C.R. stage. An examination of serial sections of 3 early embryos indicated that the coronary arteries develop epimyocardially. The myocardial bridges seem to develop concurrently with the development of myocardium. In 63% instances a bridge was present on the anterior interventricular artery, other arteries were involved less frequently.

Age, sex and socioeconomic correlates of fat patterning among adults from the Chandigarh zone of northwest India.

Fat patterns were derived from principal-component analysis of skinfolds and circumferences of 651 northwest Indian adults 18-49 years of age of high and low socioeconomic class. All measurements were corrected for absolute size prior to the analysis. As described in other ethnic groups, two patterns emerged: trunk/extremity and upper/lower body, based upon skinfolds and circumferences respectively. There was a general trend towards increases with age in upper body trunk fatness, somewhat more pronounced in upper than lower SES subsamples. Sexual dimorphism was greater in upper SES individuals due to an intensification of those patterns associated with each sex. Not only do lower SES females have less body fat than their upper SES counterparts, they have relatively less on their lower bodies (hips and thighs), which, in females, may serve as sites of energy storage.

Brief communication: coracoclavicular joint in Northwest Indians.

The incidence of an articular facet on the conoid tubercle of the clavicle indicating the presence of a coracoclavicular joint was studied in paired clavicles obtained from 1,000 adult subjects aged 18 to 95 years (748 males, 252 females), and 75 children (45 males, 30 females) of known age on whom a medicolegal postmortem had been performed by the second author during 1972-90. The subjects were inhabitants of northwest India. In addition, paired clavicles from 50 neonates and 35 fetuses were also examined. The facet was absent in the fetuses, neonates, and young children. The youngest clavicle showing the facet was from a girl of 13 years, in which it was present bilaterally. In adults the incidence of the facet was 10.1% (bilateral 5.7%, unilateral 4.4%) in males and 8.3% (bilateral 3.6%, unilateral 4.8%) in females. Absence of the facet in the fetuses, neonates, and young children shows that it is not a congenital anomaly.

Aluminium phosphide poisoning: haemodynamic observations.

Haemodynamic measurements were made on 25 patients with aluminium phosphide poisoning. There was severe hypotension (mean arterial pressure 62.7 +/- 19.3 mmHg) and reduction in cardiac output (2.13 +/- 0.9 lit/min/m2). However, the systemic vascular resistance was only moderately elevated (2050 +/- 732 dynes/m2). The right atrial pressure was increased but the pulmonary artery and pulmonary capillary wedge pressures were normal, even in patients with pulmonary oedema. Thirteen patients (52%) who died had a lower cardiac output (p less than 0.05). Saline infusion significantly improved haemodynamics in some patients. Its judicious use early in the course of treatment may be beneficial.

Age estimation from cortical index of the human clavicle in northwest Indians.

The proportion of the cortical thickness to the total diameter of the bone (cortical index) was calculated in paired clavicles obtained from 128 male and 82 female medicolegal postmortem subjects who were apparently healthy prior to their accidental death. The ages of the subjects varied from 15 to 85 years. The clavicles were cut either horizontally or parasagittally, and measurements were taken at midclavicle. From the ages of 15 to 30 years, the cortical index increased. It decreased steadily thereafter, with an initial sharp decrease in the age group 31-40 years in both sexes. After the age of 40 years, this rapid decrease in the index continued in the females, but became slow and gradual in the males. Differences between left and right sides were statistically insignificant in both sexes (P greater than 0.05). However, the sexual differences were significant (P less than 0.01) in the age groups from 41 years onwards.

Blood supply of the human interventricular septum in north-west Indians.

The blood supply of the human interventricular septum was studied in hearts obtained from 500 (300 males and 200 females) medicolegal autopsy subjects aged 18 to 75 years. In 350 specimens the coronary arteries were injected with 20 per cent solution of cellulose acetate butyrate and branches supplying the septum were displayed by dissection while in the remaining hearts the arteries were injected with a solution of barium sulphate and X-rays taken. The anterior two-thirds of the septum is supplied by 4 to 10 perforators and one or two long septal arteries (in 94 per cent instances) which arise from the anterior interventricular artery; the latter turns round the inferior border of the heart and extends for a variable distance in the caudal part of the interventricular sulcus and supplies perforators to the posterior one-third of the septum. The cephalic part of the posterior one-third of the septum gets its blood supply from the posterior interventricular artery; some variations in this arrangement have been encountered. In about 85 per cent instances the right coronary artery or its conus branch gives an interventricular septal branch which pierces the anterior wall of the right ventricle and runs subendocardially on the supraventricular crest to reach the interventricular septum where it anastomoses with the anterior perforators; about 15 per cent subjects who do not have this septal branch are likely to sustain a larger infarction in case the anterior interventricular artery gets blocked.

Time of fusion of the human sternebrae with one another in northwest India.

The time of fusion of the sternebrae with one another was studied in sterna obtained from cadavers of 806 male and 212 female adults and 66 male and 29 female children, on whom medicolegal postmortem examinations had been conducted by the senior author. Sterna of 31 neonates were also studied. The bones were X-rayed in an anteroposterior view and later macerated, cleaned, and dried. The sternebrae fused with one another from below upwards. In both sexes, the third and fourth sternebrae showed partial or commencement of fusion in a majority of specimens in the 0-5 years age group. Although the earliest complete fusion was seen in the 6-10 years age group, 100% specimens exhibited complete fusion in the 15-17 years age group. The earliest complete fusion between second and third sternebrae was observed in the 11-14 years age group in both sexes; it was seen in 100% of specimens in males over 25 years and in females over 30 years. The first and second segments showed earliest complete fusion in a boy of 16 years and in a girl of 18 years; 100% of specimens showed complete fusion in the males over 60 years and in the females over 30 years. A mesosternum showing complete fusion of all the sternebrae must be from a subject over 16 years of age if male and over 18 years if female. These observations are at variance with those of workers in Western countries. There has been no other report from India on this subject.

Origin and size of the coronary arteries in the north-west Indians.

The origin of the coronary arteries and sizes of their ostia were studied in 500 adult hearts (385 male and 115 female), obtained from medico-legal autopsies performed by one of the authors on subjects varying in age from 18 to 75 years and residents of Chandigarh zone. Third coronary artery was present in 34.8% male and 27.8% female hearts (p greater than 0.05). Whereas the incidence of the origin of right coronary artery above the supravalvular ridge was 3.4% in the males and 1.7% in females (p greater than 0.05), that of the left coronary artery was 7% in both sexes. The mean diameter of the origin of the right coronary artery in the males was 3.2 +/- 0.5 mm, and that of the females was 2.8 +/- 0.4 mm (p less than .001). The mean diameter of the left coronary artery in the males was 3.7 +/- .7 mm, and in famels 3.2 +/- .6 mm (p less than .001). The size of the left coronary artery in unsexed hearts of north-west Indian population was calculated as 3.6 mm while that of the right as 3.1 mm. The former is definitely smaller than that given in Western literature, while the size of the right artery is only marginally so. The sizes of both coronary arteries had significant correlationship with body weight, body weight, body surface area, heart weight and age. This investigation showed that the size of the coronary arteries increased with an increase in age.

Ileal band in northwest Indian subjects.

The incidence of the ileal band was recorded in 1,040 northwest Indian subjects varying in age from 1 day to 100 years on whom a medicolegal postmortem had been performed by the author. The band was present in 31.8% of male and 17.5% of female subjects (P less than .05) and was either quadrilateral (60%) or triangular in shape. In addition 25 foetuses, each above 250 mm in crown-rump length, 25 neonates, 25 monkeys (Macaca mulatta), and an equal number of dogs, rabbits, guinea pigs and rats were also dissected, but the band was found to be absent. In all the foetuses dissected and in 24 out of 25 newborns the caecum was found to be either in the subhepatic or right lumbar region. The earliest age at which the band was found was 7 months. As the band was absent in the animals and the newborns, it appears that it develops in man on account of attaining an erect posture.