Reappraisal of the classical abdominal anatomical landmarks using in vivo computerized tomography imaging.

INTRODUCTION: With expanding scope of interventions it becomes mandatory to have correct and evidence-based knowledge of surface anatomy of internal abdominal structures. Information available in text books is derived from work done on cadaveric studies. Current study was designed to provide data of key abdominal surface anatomical landmarks and their variations in living subjects using CT imaging of adult population. MATERIALS AND METHODS: Cross-sectional study was conducted using 100 abdominopelvic CT scans of patients of Indian origin. RESULTS: Vertebral levels of origin of celiac trunk varied from T11 to L1/2 intervertebral disc, superior mesenteric artery from T12 to L2, inferior mesenteric artery from L2 to L4 and aortic bifurcation from L3 to L5. Origin of both renal arteries varied between T12 and L2 and the formation of inferior vena cava varied from L3 to L5. Vertebral levels of upper pole of both kidneys ranged from T11 to upper L3. Spleen was related to 9th to 11th ribs in 36% and 10th to 12th ribs in 34% scans. Most common vertebral levels of subcostal plane, planum supracristale and planum intertuberculare noticed were lower L2, L4 and lower L5, respectively. CONCLUSIONS: Data derived from imaging investigations of living subjects and variations from the conventional descriptions observed in the current study might be helpful for clinicians.

In vitro study of iron deposition in normal human brains: An Indian Scenario.

An increase in brain iron is a normal physiological process during brain development but excess accumulation is a risk factor for various neurodegenerative diseases. Thus, knowledge of the normal range of brain iron content is mandatory. The present study was planned to collect normative data on iron deposition in human brains by in vitro analysis. Iron deposition in basal ganglia was determined by Perl's staining in 31 (18 males, 13 females) nonpathological postmortem brains aged from 18 to 80 years and by inductively coupled plasma mass spectrometry (ICP-MS) in 13 of them (seven males, six females). After conventional paraffin embedding, 5 µm thick sections were prepared, fixed and stained with freshly prepared Perl's stain along with a control section. For ICP-MS analysis, approximately 12-13 mg samples of tissue from each region of interest were dried, weighed, and digested with 2 mL of concentrated nitric acid. After digestion, the samples were dissolved in ICP grade water for trace analysis and the iron concentration was determined against standards using an ICP-MS analyzer and recorded in parts per billion (ppb). Nonheme iron deposits were observed in the globus pallidus in 16.13% of cases with no significant sex difference. Iron was deposited in the perivascular area, predominantly in the tunica media and tunica adventitia. ICP-MS analysis revealed the highest iron concentration of 595 ppb (0.595 µg/g tissue) in the globus pallidus with no significant gender or age related differences. In conclusion, the present study revealed a low (16%) incidence of brain iron deposition in normal adult postmortem brains. Clin. Anat. 31:275-281, 2018. © 2017 Wiley Periodicals, Inc.

Effects of short term growth hormone therapy in adult growth hormone deficiency.

BACKGROUND AND OBJECTIVES: Growth hormone (GH) is the most common deficient hormone in patients with pituitary disorders. Growth hormone deficiency in adults is associated with altered body composition, poor quality of life, and increased cardiovascular morbidity and mortality. There are no data available from India, on the use of GH replacement in adult growth hormone deficiency. METHODS: Twenty six male subjects with growth hormone deficiency (peak GH response <5 microg/L after appropriate stimulation) due to pituitary disorders were recruited for the study in a tertiary care institute in north India. Anthropometric parameters, body composition, isometric hand grip strength, and biochemical parameters including fasting plasma glucose, insulin, lipid profile and IGF-1 were measured. Quality of life (QOL) was assessed by standardized and validated questionnaire. The subjects were administered recombinant human growth hormone or placebo at a dose of 4 microg/Kg/day at 2000 h subcutaneously. The subjects were assessed at baseline and on completion of 12 weeks of therapy. RESULTS: The mean age of subjects was 47.0 +/- 3.9 years. There was no significant improvement in body composition, muscle strength, QOL score and glucose homeostasis, but serum triglyceride level decreased significantly (0.04) after growth hormone treatment. INTERPRETATION AND CONCLUSION: Short term use of GH replacement in subjects with adult growth hormone deficiency did not have any beneficial effect.

Predictors of metabolic syndrome in Asian north Indians with newly detected type 2 diabetes.

BACKGROUND & OBJECTIVE: The identification of metabolic syndrome (MS) among patients with type 2 diabetes (T2DM) is of great importance, since those with MS carry a cluster of cardiovascular risk factors. This study evaluates suitable criteria with high efficiency in diagnosing MS and to identify the strongest predictors of MS in newly detected type 2 diabetes individuals. METHODS: Newly detected type 2 diabetes (<6 months) patients were assessed. The MS was assessed by WHO, National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), modified NCEP-ATP-III and International Diabetes Federation (IDF) criteria. Receiver operating characteristics (ROC) curves of serum triglycerides, HDL, and waist circumference were created for the prediction of MS and the area under the corresponding curves (AUC) were used to evaluate the predictive efficiency of each MS parameter. Different cut points in the selected variables and the corresponding sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were estimated. RESULTS: Among the 563 newly detected T2DM individuals, the presence of MS ranged from 57 to 68 per cent according to the different criteria. The higher percentage of MS was observed in modified NCEPATP III criteria. In comparison to men, presence of MS was higher in women in all the four criteria [198 (67%) vs. 165 (62%); 209 (70%) vs. 111 (42%); 231 (78%) vs. 151 (57%); 222 (75%) vs. 129 (49%)] by modified WHO, NCEP-ATP III, modified NCEP-ATP III, and IDF, respectively. The predictive ability to diagnose MS was highest with modified NCEP-ATP III and lowest with IDF criteria. The optimal cut-off of waist circumference in men and women were 90 and 88 cm respectively. Serum triglyceride in men effectively indicated the presence of MS in newly detected T2DM individuals, whereas, in women the HDL-C was the stronger predictor of MS. INTERPRETATION & CONCLUSION: The study results show that modified NCEP-ATP III criteria predict highest occurrence of MS in newly detected T2DM patients. Elevated serum triglyceride for men and decreased serum HDL-C in women were the strongest single predictors, effectively indicating presence of MS in newly detected T2DM.

Prevalence and predictors of metabolic syndrome in non-obese Asian Indians with newly detected type 2 diabetes mellitus.

We measured the prevalence and have evaluated the sensitivity, specificity, positive and negative predictive value of different predictors according to different standard criteria for metabolic syndrome in non-obese newly detected type 2 diabetes. Two hundred and fifteen patients of BMI <25 kg/m2 were studied. Metabolic syndrome prevalence was high in non-obese newly detected type 2 diabetes mellitus individuals. Greater prevalence of metabolic syndrome was observed in modified WHO (50.23%) and lesser in IDF (30.69%) classification. Non-obese metabolic syndrome individuals display significantly higher BMI, per cent body fat, waist circumference, hip circumference, waist hip ratio, blood pressure, triglyceride and a lower high density lipopratein than non-obese individuals without metabolic syndrome. The cut-off point for waist circumference in men was 86 cm and 79.7 cm for women (modified ATP III). Elevated serum triglyceride for men and low serum high density lipoprotein in women were the strongest predictors that effectively indicated the presence of metabolic syndrome in non-obese individuals.