Trends in the Incidence of Spontaneous Subarachnoid Hemorrhages in the United States, 2007-2017

BACKGROUND AND OBJECTIVE

To test the hypothesis that age-specific, sex-specific, and race-specific and ethnicity-specific incidence of nontraumatic subarachnoid hemorrhage (SAH) increased in the United States over the last decade.

METHODS

In this retrospective cohort study, validated International Classification of Diseases codes were used to identify all new cases of SAH (n = 39,475) in the State Inpatients Databases of New York and Florida (2007-2017). SAH counts were combined with Census data to calculate incidence. Joinpoint regression was used to compute the annual percentage change (APC) in incidence and to compare trends over time between demographic subgroups.

RESULTS

Across the study period, the average annual age-standardized/sex-standardized incidence of SAH in cases per 100,000 population was 11.4, but incidence was significantly higher in women (13.1) compared with that in men (9.6), p < 0.001. Incidence also increased with age in both sexes (men aged 20-44 years: 3.6; men aged 65 years or older: 22.0). Age-standardized and sex-standardized incidence was greater in Black patients (15.4) compared with that in non-Hispanic White (NHW) patients (9.9) and other races and ethnicities, p < 0.001. On joinpoint regression, incidence increased over time (APC 0.7%, p < 0.001), but most of this increase occurred in men aged 45-64 years (APC 1.1%, p = 0.006), men aged 65 years or older (APC 2.3%, p < 0.001), and women aged 65 years or older (APC 0.7%, p = 0.009). Incidence in women aged 20-44 years declined (APC -0.7%, p = 0.017), while those in other age/sex groups remained unchanged over time. Incidence increased in Black patients (APC 1.8%, p = 0.014), whereas that in Asian, Hispanic, and NHW patients did not change significantly over time.

DISCUSSION

Nontraumatic SAH incidence in the United States increased over the last decade predominantly in middle-aged men and elderly men and women. Incidence is disproportionately higher and increasing in Black patients, whereas that in other races and ethnicities did not change significantly over time.

Prevalence and associations of hepatitis C viremia in hemodialysis patients at a tertiary care hospital

Hepatitis C virus (HCV) infection in hemodialysis (HD) is a significant problem. We evaluated the prevalence and associations of HCV viremia in our HD patients. All patients undergoing maintenance HD at our center were tested for HCV RNA by PCR after written informed consent. Detailed history regarding age, sex, and duration of dialysis, frequency of dialysis, blood transfusions in one year, number of dialysis centers, dialyzer reuse/fresh use, and recent laboratory data was recorded. A total of 119 patients (77 males and 42 females) were tested for HCV RNA. Thirty three (27.7%) tested positive. Duration of dialysis was significantly longer in HCV RNA positive group (P = 0.001). 45.2% of patients with duration of dialysis more than 16 months were HCV RNA positive while only 7.4% of patients with dialysis duration ≤16 months were HCV RNA positive (P < 0.001). In univariate analysis, in HCV RNA group patients, ALT, AST, and GGTP were significantly elevated and albumin was significantly lower. 39% of patients who had dialysis at more than one center were HCV RNA positive as compared to 20% for patients undergoing dialysis at single center (P = 0.024). Binary logistic regression analysis showed albumin, duration of dialysis, and serum ALT to be significant variables. Sensitivity and specificity of anti-HCV ELISA was 72.7 and 97.7%, respectively. Prevalence of HCV RNA in the HD population is 27.7%. Duration of dialysis, getting dialysis at more than one center, elevated transaminase levels, and low serum albumin are important associations for HCV RNA positivity.

Preparation, characterization, and in vitro antimicrobial assessment of nanocarrier based formulation of nadifloxacin for acne treatment

The objective of the present study was to develop a nanocarrier based formulation of nadifloxacin and to investigate its in vitro antimicrobial effect against Propionibacterium acnes. Nanocarrier based microemulsion formulations were prepared by aqueous titration method, using oleic acid as oil phase, Tween-80 as surfactant and ethanol as co-surfactant in different ratios. This procedure yielded monodisperse microemulsions exhibiting a mean droplet size in the range of 95-560 nm. This range of particle size is good to treat follicle related disorders like acne vulgaris because the size of follicles is in the range of 50-100 microm. Furthermore the optimized formulations were characterized for surface morphology by transmission electron microscopy and refractive index. The permeation studies were carried out using rat skin mounted in Franz diffusion cells. Flux of the optimised formulation was 2.24 times that of control. The diameter of inhibition zone of the microemulsion was found good but smaller than that of a clindamycin disc because of the higher therapeutic efficacy of clindamycin against P. acnes. The results indicated that the developed microemulsion shows promising results against P. acnes bacteria and may be a good approach for acne treatment.

Sexing of human hip bones of Indian origin by discriminant function analysis

The present study was carried out in terms of discriminant analysis and was conducted on 100 human hip bones (of unknown sex) of Indian origin. Based on morphological features, each of the hip bone was rated on a scale of 1-3 for sexing. Twelve measurements and five indices were recorded. The results of discriminant function analysis showed that the acetabular height (vertical diameter) and indices 1 (total pelvic height/acetabular height), 2 (midpubic width/acetabular height) and 3 (pubic length/acetabular height) were very good measures for discriminating sexes. Pelvic brim depth, minimum width of ischiopubic ramus and indices 4 (pelvic brim chord x pelvic brim depth) and 5 (pubic length x 100/ischial length) were also good discriminators of sex. The remaining parameters were not significant as they showed a lot of overlap between male and female categories. The results indicated that one exclusive criterion for sexing was index 3 (pubic length/acetabular height). In comparison with the morphological criteria, the abovementioned index caused 25% and 10.25% increase in the hip bones of female and male category, respectively.

A prospective comparison of four techniques for diagnosis of paroxysmal nocturnal hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired clonal stem cell disorder with altered expression of glycosylphosphatidylinositol (GPI)-anchored proteins, resulting in the increased susceptibility of erythrocytes to complement-mediated lysis. This study compared the available laboratory methods for detection of PNH cells and evaluated their utility in routine clinical practice. Fifty patients were evaluated by flow cytometric immunophenotyping (FCMI) using CD55 and CD59 monoclonal antibodies, PNH gel card test (GCT), Ham test and sucrose lysis test (SLT). A PNH clone was detectable in erythrocytes in 14 (28%) patients by FCMI, 13 (26%) by GCT and 10 (20%) by Ham test and SLT. The GCT and lytic tests showed 100% specificity and sensitivity was 92.8% and 71.1%, respectively. The GCT results correlated with type III cells (positive for > or =3.21% type III cells) and lytic test results correlated with CD59(-) type III cells (positive for > or =5% CD59(-) type III cells). The GCT and lytic tests were comparable in their sensitivity to detect type II cells (positive for > or =18.5% type II cells). Among the available methods, FCMI is most sensitive, can quantify and delineate PNH cells with differential expression of GPI-anchored proteins. The GCT is a useful screening tool as it is fairly sensitive, easy to perform and interpret. Well-standardized lytic tests are fairly reliable as screening tests.

Unusual features associated with cranial openings of optic canal in dry adult human skulls

One hundred and eighty six dry adult human skulls (372 sides) were studied in order to reveal the presence of unusual features--such as recess, fissure and notch--in the cranial opening of the optic canal. Recess, an extension of the lateral wall, was found in 229 (61.5%) sides. Fissure, an irregular discontinuity above the lateral recess, was observed in 158 (42.4%) sides. Notch, a gap in the posterior-most limit of the roof, was seen in 66 (17.7%) sides. These were commonly seen bilaterally. The etiology of these was attributed to the development of the optic canal. During intrauterine life the optic canal is in the form of a large keyhole shaped foramen, which slowly transforms into the adult canal. A developmental arrest at an early stage may lead to the formation of recesses and fissures.

Morphological description of combined variation of distal attachments of fibulares in a foot

An interesting case of peculiarity of the distal attachment of the three fibular muscles is reported in the left foot of a male adult cadaver of Indian origin. The fibularis brevis, just inferior to the fibular malleolus, gave off an additional slender tendon anteromedial to its main tendon. This was attached to the dorsal digital expansion of the little toe while its main tendon was inserted to the customary bone. The tendon of fibularis longus on the plantar aspect just medial to the cuboid tunnel received a prominent slip of attachment of the tendon of tibialis posterior. The fibularis tertius had two parallel-running tendons attached to the bases of the fourth metatarsal and the fourth and fifth metatarsals respectively. The combined variation of the three fibulares in a single foot has not been reported previously. The more distal attachment of the fibularis brevis in this case is a regression in evolution. Weakness of both the fibularis brevis and fibularis longus is found in pes cavovarus. The former can be used as a rotational graft in soft tissue loss of the leg.

Imaging and morphology of the paracondylar process in a dry adult human skull: a case report

An unusually long paracondylar process (PCP) was found articulating with the transverse atlantal process in a dry adult male skull. It was 13 mm long and 19 mm in circumference at its middle and projected to a lower plane than the styloid process of the same side. A radiograph revealed the structure of spongiosa of the PCP to be like mastoid cells. PCP can lead to clinical symptoms due to alterations in posture and functional limitations in neck movements. Thus awareness of this process, its topographical relations and its attendant problems is of importance to clinicians, radiologists, surgeons and chiropractors. In symptomatic cases surgical resection of this process can be attempted to relieve the symptoms. The craniovertebral junction constitutes a unique part of the somite-derived axial skeleton; the lowest part of the basioccipital component including this process develops from occipital sclerotomes. Developmental variations in this region can resemble deformities.

Incidence and morphological study of zygomaticofacial and zygomatico-orbital foramina in dry adult human skulls: the non-metrical variants

Morphological diversity in the form of multiple zygomaticofacial (ZF) foramina was studied in 165 dry, unsexed adult human skulls. Zygomatic bones revealed variation in the number of foramina on their orbital and facial aspects. These were absent in 72 (21.8%) sides. A single ZF foramen was seen in 148 (44.9%) sides. Two ZF foramina were found in 92 (27.9%) sides, out of which 29 (8.8%) sides had one zygomatico-orbital (ZO) foramen, while 63 (19.1%) sides had two ZO foramina. Three ZF foramina, a relatively uncommon occurrence, were found in 17 (5.1%) sides, which included eight (2.4%) sides with one less and nine (2.7%) sides with the same number of ZO foramina. Four ZF foramina were seen in one (0.3%) side with three on the orbital aspect, a feature not reported before. The zygomatic nerve may be disrupted on elevating periorbita from the lateral wall during orbital surgery, and care should be taken to prevent injury to the nerve during the lateral orbitotomy approach to access intraorbital soft tissue tumors.

Morphology and imaging of bony projections on sigmoid sulcus with clinical implication

Morphologically diverse osseous projections were observed on the anterior lip of the sigmoid sulcus in a study conducted on 318 dry unsexed adult human skulls belonging to the Indian race. For convenience of description, this lip was divided into a longer lateral part, a shorter medial part and a junctional angular part having bony attributes characterized into three types, crests (42.9%), plates (22.3%) and bridges (13.5%). The bridges were subtyped into incomplete (11.8%) and complete (1.7%). Crests and plates were present anywhere along this lip, while bridges were confined to the angle. Right and left differences were analyzed, which showed that the above findings were more frequent on the right than the left. Plates showed a higher incidence of variation between right and left sides as compared to crests and bridges. Five cadavers were studied, which showed retinacular bands attached to the projections blending with dura mater over the foramen magnum. It is postulated that these projections are caused by the traction of the fibrous dural bands. Axial CT scan revealed partial and complete osseous bridges spanning the sulcus. These projections are of relevance to surgeons working at the cerebellopontine angle. Their presence has not been reported previously.

Facial vein draining into external jugular vein in humans: its variations, phylogenetic retention and clinical relevance

The superficial veins, especially the external jugular vein (EJV), are increasingly being utilized for cannulation to conduct diagnostic procedures or intravenous therapies. Ultrasound-guided venipuncture is a viable possibility in cases of variations in the patterns of superficial veins, and their knowledge is also important for surgeons doing reconstructive surgery. This study was done on 89 dissected adult cadavers (178 sides) and variations in patterns of termination of the facial vein (FV) into the EJV were studied. The FV in 16 sides (9%) was found to drain into the EJV, in two main patterns: type I and type II. Type I had the FV draining into the EJV with varying degrees of obliquity in a Y-shaped (6 cases, 37.5%), U-shaped (3 cases, 18.7%), tuning-fork-shaped (2 cases, 12.5%) or N-shaped (1 case, 6.2%) pattern. Type II showed an inverted A-shaped pattern (2 cases, 12.5%) or a stepladder-shaped pattern (2 cases, 12.5%) depending on the presence of one or more connecting conduits between the FV and EJV respectively. In Macaca mulatta(rhesus monkey) a pair of vertically disposed, subcutaneous veins placed nearly side by side and of equal caliber were seen on each side of the neck. The lateral vein was the EJV while the medial one took the course of the FV in the upper oblique segment and ran parallel to the EJV in the lower segment over the sternocleidomastoid, with one or two transverse communications. The anomalous patterns found in our study could be explained in terms of the regression and retention of various parts of the veins found in the rhesus monkey, or the drainage pattern found in horse, ox and dog, where the vein from the face drain into the external jugular vein, the internal jugular vein being either absent or a small vessel accompanying the carotid artery.

Unusual facets on the acetabulum in dry adult human coxal bones: a morphological and radiological study

A smooth facet was found antero-inferior to lunate surface of 48 acetabula, in a study conducted on 315 dry adult coxal bones, 26 of which (13 pairs) were of articulated pelves. Three different shapes of the facet were oval (56.3%), piriform (22.9%) and elongated (20.8%). The prevalence of the oval facet was higher in both sexes. In 37.5% bones it extended to superior ramus of pubis and in 62.5% it was limited within the acetabular margin. They were either discrete (58.3%) or continuous with the lunate surface (41.7%). The surface configuration was flat (29.2%), concave (43.7%) or grooved (27.1%). One male articulated pelvis showed a bilateral presentation. Measured along the long axis the size varied between 11 to 17 mm. The radiographs showed notching, antero-inferior to acetabular margin in grooved facets whereas concave and flat facets were seen as areas of rarefaction. It is postulated that this facet could be a consequence of a particular posture which results in traction of the ligaments attached to this area. This unusual feature has not been reported earlier.

Anatomical description and frequencies of bony projections on the cerebral aspect of the petromastoid part of the temporal bone in dry adult human skulls

A morphological peculiarity was observed in the form of bony projections on the upper part of the medial border of the groove for the sigmoid sulcus on the internal surface of the mastoid part of the temporal bones. In a study on 636 temporal regions of 318 dry unsexed adult human skulls of Indian origin, 101 (15.9%) temporal bones exhibited these elevations. These ranged from being inconspicuous tubercles to well-defined sharp spines. In 73 (72.3%) cases, a projection was present unilaterally, more commonly on the right side and in 28 (27.7%) it was bilateral. A subjective assessment of the size showed the projections to be small (70; 69.3%), medium (16; 15.8%) and large (15; 14.8%).

Variation in shape of the lingula in the adult human mandible

The lingulae of both sides of 165 dry adult human mandibles, 131 males and 34 females of Indian origin, were classified by their shape into 4 types: 1, triangular; 2, truncated; 3, nodular; and 4, assimilated. Triangular lingulae were found in 226 (68.5%) sides, truncated in 52 (15.8%), nodular in 36 (10.9%) and assimilated in 16 (4.8%) sides. Triangular lingulae were found bilaterally in 110, truncated in 23, nodular in 17 and assimilated in 7 mandibles. Of the remaining 8 mandibles with different appearances on the 2 sides, 6 had a combination of triangular and truncated and 2 had nodular and assimilated. The incidence of triangular and assimilated types in the male and female mandibles are almost equal. In the truncated type it was double in the male mandibles while the nodular type was a little less than double in the female mandibles.

Morphologic and imaging studies of duplicate optic canals in dry adult human skulls

Three dry adult human skulls, two with bilateral and one with unilateral duplication of the optic canal were found. Their gross morphologic features were studied. Optic canals were separated by a septum of variable thickness dividing the posterior part of the canal into a large canal in the usual position and a smaller one inferior to it. The skull with unilateral duplication of the right side had a bony bar forming the carotico-clinoid canal. One of the skulls was disarticulated and its sphenoid had bilaterally duplicated optic canals divided by thin septa, both having a slit. Conventional radiography and CT scans for the optic canal were performed on two of these skulls but not on the disarticulated bone, and the imaging representations of these features were correlated with the anatomic findings on the dry skull.

Upregulation of connexin 26 is a feature of keratinocyte differentiation in hyperproliferative epidermis, vaginal epithelium, and buccal epithelium

In epidermis, it has been suggested, intercellular communication through gap junctions is important in coordinating cell behavior. The connexins, may facilitate selective assembly or permeability of gap junctions, influencing the distribution of metabolites between cells. Using immunohistochemistry, we have compared the distribution of connexins 26 and 43 with that of proliferating cells (Ki67 labeling) in normal epidermis, hyperplastic epidermis (tape-stripped epidermis, psoriatic lesions, and viral warts), and vaginal and buccal epithelia. Connexin 43 was abundant in spinous layers of all epidermal specimens and in vaginal and buccal epithelia. Connexin 26 was absent from the interfollicular and interductal epidermis of normal hair-bearing skin, and nonlesional psoriatic epidermis but present at very low levels in plantar epidermis. Connexin 26 was prominent in lesional psoriatic epidermis and viral warts and in vaginal and buccal epithelia. In three independent experiments connexin 26 appeared in a patchy intercellular distribution in the basal epidermis within 24 h of tape stripping, proceeding to more extensive distribution in basal and suprabasal layers by 48 h. The increase in connexin 26 preceded that in cell proliferation. In vaginal epithelium, buccal epithelium, and viral warts connexin 26 was restricted mainly to suprabasal, nonproliferating cells. In psoriatic lesional epidermis connexin 26 was also located mainly in suprabasal, nonproliferating cells. Connexin 26 was present in a patchy distribution in the basal layer of psoriatic lesional epidermis, but double labeling for connexin 26 and Ki67 showed that many connexin 26 positive basal cells were nonproliferative, suggesting that connexin 26 may be related to differentiation rather than to proliferation. These observations would be consistent with a role for connexin 26 containing gap junctions during both early and later stages of keratinocyte differentiation in hyperplastic epidermis and in vaginal and buccal epithelia.

Os capitatotrapezoid: a case report

A case of fused capitate and trapezoid, the os capitatotrapezoid (OCT), was found in an articulated right hand of a male skeleton. Fusion was almost complete except for shallow grooves demarcating the line of fusion on the proximal and distal aspects. Radiology revealed a normal trabecular pattern and no joint cavity within these fused bones. The styloid process of the third metacarpal was absent.

Morphology of human suprarenal glands: a parameter for comparison

Forty suprarenal glands were studied, 20 being dissected from aborted fetuses of 9 to 36 weeks' gestation and 20 obtained from human cadavers of ages 1 day to 60 years. All the specimens were from a Northern India population. The side and shape of each suprarenal gland was noted and documented. The length, breadth, thickness and volume of each gland were measured and tabulated in terms of age. The mean length, breadth and thickness in fetuses of 9-36 weeks were found to be 1.4 cm, 1 cm and 0.45 cm respectively. In the postnatal age group the measurements were 4.5 cm, 2.08 cm and 0.66 cm respectively. The commonest shape of the suprarenal glands on left side was semilunar but on the right side it was highly variable: triangular, tetrahedral, inverted Y or V shaped. On comparison of the gross measurements with available ultrasound and CT scan data it was found that both the length and thickness in the population studied were greater than reported in the literature. A knowledge of these variations is very important in diagnosis of abnormalities of the suprarenal gland, of which tumoral enlargement is rather common.

Changing patterns of gap junctional intercellular communication and connexin distribution in mouse epidermis and hair follicles during embryonic development

In the mouse embryo between embryonic days 12 (E12) and 16, regular arrays of epidermal placodes on the mystacial pad develop into whisker follicles. This system was chosen for analysis of gap junctional intercellular communication during differentiation. The patterns of communication were studied by microinjection of the tracers Lucifer yellow-CH (LY-CH) and neurobiotin (NB), while immunofluorescent staining was used to study distribution of connexins 26 and 43. Extensive communication was seen between keratinocytes in developing hair pegs or, in later-stage hair follicles, in the germinative matrix. Coupling between adjacent hair pegs via interfollicular epidermis was not observed. Coupling also became restricted as follicular cells differentiated to form outer root sheath, inner root sheath, and hair shaft. Extensive gap junctional coupling is characteristic of keratinocytes that are rapidly proliferating (as in hair pegs and germinative matrix). Follicular keratinocytes commence differentiation shortly before restriction of gap junctional coupling becomes evident. Dermal mesenchymal cells undergoing different modes of differentiation also exhibit differences in gap junctional coupling, as evidenced by poor transfer of LY-CH between cells in dermal condensations of hair follicles compared with extensive transfer elsewhere in the dermis. LY-CH and NB were not transferred between epidermal or follicular epithelium and mesenchyme, arguing against a direct role for gap junctions permeable to known second messenger molecules or nucleotides in epithelial-mesenchymal interactions in this system. The distribution of connexins 26 and 43 in epidermis and hair follicles changed during differentiation but there was no correlation with changing patterns of dye transfer, indicating an unexpected degree of complexity in the relationship between gap junctional intercellular communication and connexin protein distribution during development.

Academic performance of various categories of students admitted to Lady Hardinge Medical College, New Delhi

A retrospective study of 4 consecutive academic batches of students was conducted to analyse the performance level of students in 3 university examinations of MBBS. The students were divided into 3 categories based on the criteria of entrance into the medical college. The category I included students who entered through a tough pre-medical test, category II comprised those nominated by government and defence personnel and category III included the Schedule Caste and Schedule Tribe students. The results of the category I was remarkably better than that of II while that of category III was dismal. The last two categories had a large number of students leaving the college without completing their course resulting in 5.4% wastage of precious medical seats and psychological distress. Necessary remedial measures must be planned at the earliest.

Facial vein terminating in the external jugular vein. An embryologic interpretation

The external jugular v. (EJV) is increasingly being used for therapeutic procedures and monitoring by clinicians. In view of this clinical relevance, dissection was done on the head and neck regions in 40 adult cadavers of Indian origin to detect variations of the EJV. Though several patterns of tributaries were found, a facial v. (FV) of considerable size was observed coursing obliquely to join the EJV in the neck in four cases (5%). The distance of the junction of the FV and the EJV from the angle of the mandible ranged between 55 and 104 mm. This may represent a persistent communication of the primitive linguofacial v. with the secondarily developing EJV. This anastomotic channel is present for some time in the fetus but later undergoes retrogression. Its persistence in some individuals results in this variation.

Double-lumen esophagus: formation of a new lumen or septation of the existing one?

Presented here are two cases in which two esophageal lumens were identified at endoscopy. One patient had a history of antireflux surgery and both patients had received esophageal dilations. Both patients have done poorly with standard esophageal dilation and are not considered likely to gain from surgery. The mechanism of formation of the second lumen is not certain in Case 1, but in Case 2 a self-contained perforation appears to be the likely mechanism. There is no clear definition of "double-lumen esophagus" in the literature. The term is used at times interchangeably with esophagogastric fistula. We propose that the phrase "double-lumen esophagus" is a morphologic description and should be used only when the two lumens are of nearly equal diameter. The term "fistula" should be used whenever that is the likely mechanism. Hence, Case 1 of our report is the true double-lumen esophagus, while Case 2 is an esophagogastric fistula. Since patients do poorly with standard dilation, newer endoscopic modalities may have a role in the management of these rare but difficult cases.

Mastoid canals in adult human skulls

Mastoid canals (tunnels) were observed in 41 (7.7%) of 265 dry human skulls. The canals were 2-27 mm long. This feature has not been reported before. dissection of 30 mastoid regions in cadavers showed that the canals contained a branch of the occipital artery and a vein. It is possible that during development of the mastoid process the squamous temporal bone ossifies over the vessels, giving rise to the canals.

Precondylar tubercles on the basiocciput of adult human skulls

The basiocciput of 265 Indian adult human skulls was examined for precondylar tubercles, which are single or paired osseous formations anterior to the occipital condyles and foramen magnum. Of the 14% of skulls displaying these tubercles unilaterally or bilaterally, 5.3% demonstrated ridges, 4.9% showed spines and 3.8% exhibited processes. Sexual dimorphism was evident with female skulls showing a higher incidence (8.7%) compared with male skulls (5.3%). The corresponding atlas vertebrae were normal. These craniovertebral anomalies may have clinical relevance for lesions at the foramen magnum.

Submandibular gland with multiple ducts

A morphological peculiarity was observed in the form of a submandibular gland having three ducts. These ducts opened separately into the oral cavity. Only the upper and the largest of these three ducts was in the usual position and had the expected relation to the lingual nerve. Such a condition is to be kept in mind by a surgeon or a radiologist performing sialography. Unless each of the duct in instilled he may miss pathological findings.

Internal fixation or hemiarthroplasty for undisplaced fractures of the femoral neck in octogenarians

We compared the reoperation rate after internal fixation for minimally displaced or impacted intracapsular fractures of the femoral neck in patients aged 80 years and above with that in similar patients aged 65 to 79 years. We also compared the results of internal fixation with those of hemiarthroplasty for displaced intracapsular fracture in an age- and sex-matched group of elderly patients. We found that a significantly greater proportion of the older patients treated by internal fixation required reoperation than either the younger group or the age-matched group treated by hemiarthroplasty. Our results indicate that internal fixation may not be the best treatment for extremely elderly patients with minimally displaced or impacted intracapsular fractures of the femoral neck.

Internal fixation or hemiarthroplasty for undisplaced fractures of the femoral neck in octogenarians

We compared the reoperation rate after internal fixation for minimally displaced or impacted intracapsular fractures of the femoral neck in patients aged 80 years and above with that in similar patients aged 65 to 79 years. We also compared the results of internal fixation with those of hemiarthroplasty for displaced intracapsular fracture in an age- and sex-matched group of elderly patients. We found that a significantly greater proportion of the older patients treated by internal fixation required reoperation than either the younger group or the age-matched group treated by hemiarthroplasty. Our results indicate that internal fixation may not be the best treatment for extremely elderly patients with minimally displaced or impacted intracapsular fractures of the femoral neck.

Autophor cementless total hip arthroplasty for osteoarthrosis secondary to congenital hip dysplasia

The authors present a consecutive series of 38 arthroplasties for osteoarthrosis secondary to hip dysplasia. All arthroplasties were performed by a single surgeon using Mittelmeier II (Autophor, Osteo AG, Selzach, Switzerland) ceramic cementless components. Crowe grades of subluxation were 60% grade I, 16% grade II, 12% grade III, and 12% grade IV. In all cases, the acetabular component was seated in the true acetabulum. The mean follow-up period was 75 months (range, 40-122 months). By the time of review, six hips (16%) had required revision for aseptic loosening, mainly of the femoral component. Good or excellent results were achieved in only 63% of the patients. In the group of surviving arthroplasties, the median Charnley hip scores before surgery were: pain, 2; movement, 3; and walking, 3. After surgery, the scores were: pain, 5; movement, 5; and walking, 6. All improvements were significant. The mean postoperative Harris hip score was 84. Poor scores were associated with contralateral hip disease (2 cases) and spina bifida (2 cases), significantly affecting function. The Autophor prosthesis can produce satisfactory results in some of these young patients with hip dysplasia. However, femoral loosening is a major problem and because of this, the authors have since changed to a newer stem design.

Localization of androgen receptors in human skin by immunohistochemistry: implications for the hormonal regulation of hair growth, sebaceous glands and sweat glands

A mouse monoclonal antibody against the N-terminal region of human androgen receptor (AR) was used to identify receptors by immunoperoxidase staining in frozen serial sections of skin from scalp, face, limb and genitalia of men and women aged 30-80 years. AR staining was restricted to cell nuclei. In sebaceous glands, AR were identified in basal and differentiating sebocytes. The percentage of receptor-positive basal sebocyte nuclei in the temple/forehead region was greater in males (65%) than in females (29%). AR staining was restricted to the cells of dermal papillae in anagen and telogen hair follicles. The percentage of dermal papillae containing AR was greater in males (58%) than in females (20%). The number of positively stained dermal papillae was lowest in female scalp skin. In 163 hair follicles sectioned, AR were absent from germinative matrix, outer root sheath (including the bulge region), inner root sheath, hair shaft and hair bulb, and from the capillaries present in some large dermal papillae. AR were present in pilosebaceous duct keratinocytes, suggesting that androgens may influence pilosebaceous duct keratinization. AR were also identified in interfollicular epidermal keratinocytes and dermal fibroblasts although, in both cell types, intensity and frequency of staining were greatest in genital skin. AR were identified in luminal epithelial cells of apocrine glands in genital skin and in certain cells of the secretory coils of eccrine sweat glands in all body sites. This study indicates that androgens regulate sebaceous gland and hair growth by acting upon two different types of target cells, the epithelial sebocytes of sebaceous glands and the mesenchymal cells of the hair follicle dermal papilla.(ABSTRACT TRUNCATED AT 250 WORDS)

Duplication of optic canals in human skulls

Three human skulls showing duplication of the optic canal are reported. Two had bilateral duplication while one had duplication on one side only. The measurements of the whole canal were within the range of normal. Septa of variable thickness separated the main and the accessory canals in these skulls and the skulls also showed a tendency to excessive bone formation.

Segmental epidural analgesia for labor and delivery

A study to evaluate segmental epidural analgesia in labor is described. Bupivacaine (0.25 per cent) was used during the first stage of labor and for the second stage, either 3 per cent - Chloroprocaine delivered through the catheter (Group I) or 1 per cent Lidocaine as a perineal infiltrate (Group II) was used. There were 124 full term patients of whom, 36 were nulliparous and 88 were multiparous. The effects of segmental epidural analgesia on maternal blood pressure, pain relief, preservation of lower limb motor power, duration and progress of labor, and fetal outcome were evaluated. Pain relief during the first stage of labor was satisfactory in 114 (92 per cent) of the patients. There were no significant changes in maternal blood pressure, motor power in lower limbs, efficiency of uterine contractions and internal rotation of the presenting part when analgesia was effective. The use of 2-Chloroprocaine for second stage pain relief required low forceps delivery in 84 (91 per cent) patients, as compared to 14 (44 per cent) patients that had 1 per cent Lidocaine local infiltration. Fetal outcome, was excellent in all cases in that the one minute Apgar score was never lower than 7.