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   Table of Contents - Current issue
Coverpage
January-March 2021
Volume 70 | Issue 1
Page Nos. 1-58

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EDITORIAL  

Discovery of new organs in human throat: The tubarial salivary glands Highly accessed article p. 1
Vishram Singh, Krishna Chaitanya Reddy
DOI:10.4103/jasi.jasi_240_20  
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ORIGINAL ARTICLES Top

Morphometric study of the knee joint in Saudi Arabian population based on magnetic resonance imaging scan p. 3
Daifallah Alharbi, Zaheer Ahmed
DOI:10.4103/JASI.JASI_135_20  
Introduction: Total knee arthroplasty (TKA) is considered a highly recommended procedure, to improve the life of patients suffering from knee arthritis by relieving pain and deformity. Knee morphology and anthropomorphic features have evolved as the most reliable source of information to design TKA prostheses. But unfortunately, the amorphic features of Western patients are the preferred choice of data for the development of suitable implants. This study is conducted for commencing to evaluate the geometric parameters of the knee joints of Saudi Arabian male and female subjects which is indispensable to the design of knee prosthesis used for compatriotic patients. Material and Methods: A total of 13 parameters of tibia and femur were studied in a group of 150 normal subjects including 110 females and 40 males. A subsequent magnetic resonance imaging scan was done for all the studied cases and a reproducible result was obtained. Results: The Saudi females were found to have smaller dimensions of parameters of tibia and femur than those in Saudi males. The results when compared with other reports from different countries, we find marked difference in their dimensions. Discussion and Conclusion: Our study suggests that there exists a morphological mismatch between the knee anatomy of people of Saudi Arabia and people of other countries. Implantation of such implants prepared on the basis of outsider data could not justified to use in the Saudi population.
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Aberrant right subclavian artery: A multi-detector computed tomography study p. 11
CS Ramesh Babu, Om Prakash Gupta, Arjun Kumar
DOI:10.4103/JASI.JASI_129_20  
Introduction: Aberrant right subclavian artery (ARSA) arises as the last branch of normally positioned aortic arch and its prevalence estimated as 0.16%–2.0% varies between different ethnic groups. Our aim was to assess the prevalence and associated branching anomalies of ARSA in the Indian participants. Material and Methods: Chest computed tomographic scans of 710 patients were analyzed to study the ARSA and its associated vascular anomalies. Results: We have observed 11 cases (5 in males and 6 in females) of ARSA with an estimated prevalence of 1.54%. In seven cases, there were four branches arising from the arch of aorta in the order of right common carotid, left common carotid, left subclavian, and aberrant right subclavian. In three cases, there were three branches – bicarotid trunk (common trunk of right and left carotids), left subclavian, and the aberrant right subclavian. In one case, there were five branches in the order of right common carotid, left common carotid, left vertebral, left subclavian, and aberrant right subclavian. Only two participants reported mild symptoms of dysphagia. In all the cases, the ARSA had retroesophageal course. Kommerell diverticulum was not observed. ARSA remain asymptomatic in most cases, but its presence should alert the clinician to look for associated vascular and any cardiac anomalies. Discussion and Conclusion: Awareness of the presence of ARSA is crucial for successful outcome of mediastinal, esophageal, and thoracic spine surgeries. Preprocedural computed tomography for the evaluation of aortic arch branching pattern will be beneficial for the successful performance of various surgical and radiological interventions.
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Estimation of gestational age by ultrasound measurement of fetal transcerebellar diameter p. 19
Maheswari Cinnusamy, Deepti Shastri, Josephine Arokia Martina
DOI:10.4103/JASI.JASI_142_20  
Introduction: Transcerebellar diameter (TCD) normogram predicts gestational age (GA) with an accuracy of 94% in the third trimester. The study aims to evaluate the application and accuracy of Transcerebellar diameter in determining the GA of the fetus and Its Correlation. Material and Methods: A cross-sectional prospective study conducted to determine the different antenatal ultrasound examinations were performed in 100 normal healthy pregnant with single fetus women having between 25 and 32 weeks of gestation. Results: Mothers mean GA on ultrasound was 28.4 ± 0.75 (27–30.2) weeks. The mean fetal biometry parameters including biparietal diameter (BPD) was 73 ± 2.3 mm (67–80), head circumference (HC) was 264 ± 8.7 mm (237.8–311), abdominal circumference (AC) was 244 ± 8.9 mm (226.6–265.9), femur length (FL) was 55 ± 2.1 mm (49.5–59.6), fetal heart rate was 149 ± 8.5 beats (121–175). The mean transcerebellar (TCD) measurement was 31 ± 1.1 mm. The correlation coefficient between the period of gestation and TCD was found to be 0.99 at 27–30 weeks which was statistically significant (P < 0.001) (r > 0.99). Discussion and Conclusion: From the present study, it was observed that the TCD increases linearly with GA. The correlation between GA and the GA by TCD seems to increase from 28 to 30 weeks. There is a good correlation between GA derived from TCD and from established biometric indices like BPD, HC, AC, and femur length.
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Study of histological changes of placenta in pregnancy-induced hypertension in poorvanchal region of Uttar Pradesh, India p. 25
Vishram Singh, Kumud Ranjan, SL Tewarson, Rashi Singh, Yogesh Yadav
DOI:10.4103/jasi.jasi_271_20  
Introduction: The placenta is a fetomaternal organ. It is a connection of the fetus with the uterine wall of mother. Through the placenta, exchange of gases and nutrient supply takes place. Through the placenta, fetal blood tissue comes in direct contact with the maternal blood without any rejection. It is a special transient organ of pregnancy. In our study, we carried out the microscopic examination of the placenta in pregnancy-induced hypertension, i.e., syncytial knot, cytotrophoblastic cellular proliferation, fibrinoid necrosis, endothelial proliferation, and calcified villous spot. Material and Methods: One hundred and fifty-two placentas of full-term pregnancy were collected from the labor room/operation theater of the Gynecology and Obstetrics Department of the Government Medical College and Superfacility Hospital Azamgarh. Out of one hundred and fifty-two placentas, 76 cases were controls from mothers with no known history of preexisting hypertension and 76 were collected from mothers with pregnancy-induced hypertension. Placentas were kept in 10% formalin for 24 h for fixation. After 24 h, tissues of placentas were passed through a series of the procedures from dehydration and clearing to wax impregnation before being sectioned from automated microtome. Time took for processing was 24 h. Five microns thick tissues sections were cut. Prepared slides were mounted in DPX and covered with the cover slip. Through binocular light, microscope slides were examined at ×10, ×40, and ×100 magnifications. Results: Histology in our study revealed that syncytial knots were present in placentas of all 100% of hypertensive and only 32.89% of normotensive mothers. Cytotrophoblastic proliferation was seen in 98.68% and 19.73% placentas of hypertensive and normotensive mothers, respectively. Fibrinoid necrosis of placenta was found in 88.15% of hypertensive and only 28.94% of normotensive mothers. The 100% placentas of the hypertensive mothers had endothelial proliferation as compared to controls. Calcified villous spots were seen in 84.21% and 31.57% of placentas of hypertensive and normotensive mothers, respectively. Discussion and Conclusion: Pregnancy-induced hypertension adversely affects the health of the fetus through its harmful effects on the placentas. Syncytial knots, cytotrophoblastic cellular proliferation, fibrinoid necrosis, endothelial proliferation, and the calcified villous spots were present more in the placentas of hypertensive mothers in our study in comparison to the study of other authors. In our research, we found that endothelial proliferations were present in all placentas. If proper treatment is given to the mother in the early stage of pregnancy, it may prevent the death of a fetus. Hence, this study helps the clinician for early diagnosis and treatment of pregnancy-induced hypertension.
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Vascular anatomy of distal end of femur and its clinical implications p. 30
Deepa Bhat, Sunilkumar Doddaiah, Pushpalatha Murugesh, NB Pushpa
DOI:10.4103/JASI.JASI_34_20  
Introduction: The distal end of the femur is a highly vascular tissue with unique features in its blood supply. The outcome of surgical interventions is determined by the interference of corresponding blood supply. The study examines the pattern of blood supply in terms of density, size, and direction of vascular foramina (VF) to the distal end. Material and Methods: The lower end of normal adult dry femora (n = 300) was divided into segments. The number, size, and direction of VF in each segment were documented. Wilcoxon signed-rank test identified the statistical difference in the number of VF between various segments and Friedman test compared the difference between segments of two sides. Results: The maximum average number of VF was observed in medial condylar surface while minimum in central part of intercondylar region. Condylar medial recorded the highest number of VF of all sizes. The number of VF of >2 mm size was found to be significantly different between right and left in right condylar lateral and right intercondylar posterior regions. Right condylar lateral had considerably large number of VF of >2 mm size with statistical significance (P = 0.000). A Friedman test indicated that segements of two sides rated differently. Discussion and Conclusion: The density of VF through which vessels traverse at lower end were not only numerous but also constant and uniformly scattered. Detailed understanding of the arterial anatomy of lower end helps to identify and localize vascular pedicles, thus ensuring vitality of graft as well as donor site.
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Sheath of distal tendon of semimembranosus muscle and it's functional significance p. 35
Subhash D Joshi, Sharda S Joshi, Namrata Valimbe
DOI:10.4103/jasi.jasi_206_20  
Introduction: Semimembranosus (SM) muscle is important in maintaining the stability of knee joint, and the distal end of it's tendon is not only complex but has been described differently in the available literature, which is quite perplexing. How a muscle with such divergent attachments can efficiently perform it's functions? Hence a detailed study of the distal semimembranosus tendon unit was undertaken. Material and Methods: One hundred lower limbs (Rt-50; lt.-50) were utilized for the present study. The posterior surface of SM was exposed and as the main tendon could not be traced to its insertion hence a vertical incision was made on the posterior surface of this tendon and this lead to the splitting of the tendon-sheath which exposed the thick shining distal tendon of SM. Results: Surprisingly, it was found that the main tendon of the SM (SMT) was surrounded by a fibrous sheath which was derived from the main muscle mass in the lower part of the thigh and in the majority of cases it was separated from it by a synovial space. Traced inferiorly it was observed that it is the sheath that spreads out to various divergent destinations described in the literature, whereas the main tendon gets attached to the groove on the posterior aspect of the medial condyle of tibia and a rough triangular area below the groove. Discussion and Conclusion: It is the nature's ingenuity that a single muscle with such divergent distal attachments can still efficiently perform its functions due to the formation of a sheath of distal tendon of SM.
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Evaluation of morphometric and volumetric measurements of temporomandibular joint structures on patients with disc displacement p. 41
Melike Basaran, Esin Bozdemir, Sehnaz Evrimler
DOI:10.4103/JASI.JASI_77_20  
Introduction: To evaluate the morphometric and volumetric measurements of the temporomandibular joint (TMJ) structures, of healthy, anterior disc displacement with reduction (ADDWR) and anterior disc displacement without reduction (ADDWoR) joints using magnetic resonance imaging (MRI). Material and Methods: Fifty-two TMJs of 38 patients with TMJ disorders and 26 TMJs of 13 healthy patients were evaluated on MRI images. The disc length and volume, the condylar height, width and volume, and the height and inclination of the articular eminence were measured on MRI. A one-way analysis of variance was used to establish the differences between the values with regard to the ADDWR, ADDWoR, and control groups. The differences in the disc volumes of each group with respect to open and closed mouth position statuses were evaluated using the Bonferroni test. Results: The articular disc mean volume was larger in the control group than the other two groups for both the closed and open mouth positions (P < 0.05). There were statistically significant differences between the control group and the other two groups in terms of the condylar width and disc length (P = 0.00 and P = 0.001, respectively). The mean articular eminence inclination was the lowest in the ADDWoR group and the highest in the control group (P = 0.02). Discussion and Conclusion: Measurements of the disc volume, disc length, condylar width, and articular eminence inclination are associated with disc displacement (DD). Degenerative changes that may cause morphometric and volumetric changes in TMJ structures may be a marker of TMJ DD.
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Analysis of vertical forces in children with down's syndrome by using emed® capacitance-based pressure platform p. 48
Venkata Nagaraj Kakaraparthi, Vamsi Krishna Gannamaneni, Lalitha Kakaraparthi
DOI:10.4103/JASI.JASI_148_20  
Introduction: This study aimed to analyze the vertical forces functioning under the plantar surface of the feet in children with and without Down's syndrome (DS) during walking using a capacitance-based pressure platform (emed®). Material and Methods: This is an observational study on 10 individuals with DS, (Group I) and 10 children without DS (Group II), aged 8–15 years. Both the groups were evaluated while standing on a capacitance-based pressure platform. Maximum force, peak pressure, contact time, and contact area parameters were assessed for both right and left foot. In this study, we assessed and compared these parameters in both the groups. Results: The results showed that the foot-ground interaction forces varied between the two groups. In particular, parameters such as maximum force, peak pressure, and contact area were statistically significant, where no significant difference was found concerning the contact time parameter. Discussion and Conclusion: The capacitance-based pressure platform (emed®) must be considered an essential evaluation tool for assessing vertical forces associated with children with DS. Thus, organizing regular monitoring of foot-ground reaction forces during the early years in DS children is suggested to prevent potential complications associated and decrease the probability of mobility impairments in adulthood.
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CASE REPORTS Top

Incidentally detected anomalous pectoralis major muscle during reconstruction of oral cavity cancer p. 52
Amitabh Jena, Gajjala Sivanath Reddy, Rashmi Patnayak, Sarla Settipalli
DOI:10.4103/JASI.JASI_239_19  
The congenital deficiency of pectoralis major muscle is quite uncommon. Only a few cases are described in the literature that too in cadavers. Recently, we came across a case of deficient pectoralis major while harvesting pectoralis major myocutaneous (PMMC) flap for reconstruction following right composite resection for carcinoma of the right buccal mucosa in a 50-year-old female. The external appearance of the anterior chest wall was normal. During surgery, we found that the clavicular head and sternal portion of the sternocostal head of the right pectoralis major muscle were absent and the costal portion of the sternocostal head was deficient over the medial aspect. A normal pectoralis minor was present. This deficiency may be congenital in nature. We present this case to highlight this uncommon condition, and this may be the only case report till now wherein deficient pectoralis major was used for PMMC flap reconstruction of oral cavity defect.
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An unusual variation of infrahyoid musculature and its clinical implications p. 55
Eva Maria Gonzalez-Soler, Arantxa Blasco-Serra, Francisco Martinez-Soriano, Alfonso A Valverde-Navarro
DOI:10.4103/JASI.JASI_219_19  
Knowledge of the anatomy of musculoskeletal system of the anterior neck region is crucial for the good practice of health personnel. In this area, both muscular and vascular systems are closely related, and the anatomical variations that may occur could alter blood conduction or hinder medical and surgical maneuvers. This study reports a case of unilateral duplicated omohyoid muscle and its merger with an anomalous sternohyoid muscle with an intermediate tendinous formation and discusses its clinical importance. This alteration might have represented a problem at a surgical reconstruction of diverse neck structures, in case of having specified one. Besides, a large-flow collateral vein system has been observed, which could also have played an important role in the consequences of this anatomical muscle variation. Thus, it is considered as of importance to report on the anatomical variations found in human dissections, both for basic science researchers and for professionals dedicated to clinical science.
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OBITUARY Top

Dr. Vishwanath Ramrao Mysorekar (Dec 1931 - Dec 2020) p. 58
GM Mahesh
DOI:10.4103/jasi.jasi_41_21  
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