Vascularity of human atrioventricular valves: A myth or fact?

BackgroundKnowledge of heart valve vascularity is an important factor for understanding the valvular pathology and to develop tissue-engineered valves for repair procedures. Some investigators believe that blood vessels may exist in normal human heart valves whereas some recent publications have proposed that the presence of blood vessels in the valves is secondary to inflammation.MethodsTissues from 60 normal formalin-fixed human hearts were examined microscopically for type, location, and number of vessels in atrioventricular valves. The age of the patient ranged from 10 to 70 years, and an attempt was made to study the age-related morphologic changes in atrioventricular valves.ResultsOf the 60 tricuspid and 60 mitral valves examined, 12 tricuspid (20%) and 14 mitral (23.33%) valves were found to have vessels without the presence of an inflammatory process. In tricuspid valves the vessels were observed mainly in the fibrosa layer with a range of 1 to 4 vessels, whereas in mitral valves the vessels were situated mainly in the spongiosa layer with a range of 1 to 2 vessels. The maximum vascularity was seen in the fourth decade of life, in which the vessels were found in 40% of both tricuspid and mitral valves. The mean transverse diameter of these vessels was 0.23 ± 0.18 mm, with a range of 0.06 to 0.79 mm in tricuspid valves, whereas it was 0.15 ± 0.08 mm, with a range of 0.04 to 0.4 mm in mitral valves. The capillaries (3-11 capillaries) were found scattered in the fibrosa and spongiosa with an average lumen area of 0.39 ± 0.18 mm2.ConclusionsThe blood vessels in atrioventricular valves also can be seen in the absence of inflammation and are likely to be a necessary component of valve leaflets. Thus, when performing procedures involving in situ tissue engineering and valve repair the physician needs to be aware of the presence of these vessels in human heart valves

Choroid Plexus of the Fourth Ventricle: Review and Anatomic Study Highlighting Anatomical Variations

Relatively few studies have been performed that analyze the morphology of the choroid plexus of the fourth ventricle. Due to the importance of this tissue as a landmark on imaging and during surgical intervention of the fourth ventricle, the authors performed a cadaveric study to better characterize this important structure. The choroid plexus of the fourth ventricle of 60 formalin fixed adult human brains was examined and measured. The horizontal distance from the midline to the lateral most point of the protruding tip of the horizontal limbs was measured. In the majority of the 60 brain specimens, right and left horizontal limbs of the choroid plexus were seen extending from the midline and protruding out of their respective lateral apertures of the fourth ventricle and into the subarachnoid space. However, on 3.3% of sides, there was absence of an extension into the foramen of Luschka and in one specimen, this lack of extension into the foramen of Luschka was bilateral. On two sides, there was discontinuity between the midline choroid plexus and the tuft of choroid just outside the foramen of Luschka. For specimens in which the choroid plexus did protrude through the foramen of Luschka (96.7%), these tufts were located anterior to the flocculus and inferolateral to the facial/vestibulocochlear nerve complex and posterosuperior to the glossopharyngeal/vagal/accessory complex. A thorough understanding of the normal and variant anatomy of the fourth ventricular choroid plexus is necessary for those who operate in, or interpret imaging of, this region

Diffuse Idiopathic Skeletal Hyperostosis: An Anatomical Case Report

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a noninflammatory disease of unknown cause characterised by osteophytic calcification or ossification of ligaments and enthesis; especially spinal. Authors hereby present a case report of a 65-year-old male cadaver, in whom the fusion of contiguous nine vertebrae from fifth thoracic to first lumbar vertebrae, because of ossification of the Anterior Longitudinal Ligament (ALL) was noticed. The tenth and eleventh thoracic vertebrae seemed to be affected worse, as maximum osseous anterior outgrowth (12 mm) of ossified ALL, ossification of Ligamentum Flavum (LF) and supraspinous ligament was also observed at this level. The Ossification of Anterior Longitudinal Ligament (OALL) along with the involvement of LF has not been classically reported. Ossification of spinal ligaments may cause local thoracic pain, stiffness and slowly progressive myelopathy. Ossified LF at the level of joint between tenth and eleventh thoracic vertebrae may result in compression of spinal cord at this level

Harvesting split thickness costal cartilage graft

Aim: There are few complications associated with harvesting of full thickness coastal cartilage grafts i.e., pneumothorax (0.9%), contour deformities and prolonged post-operative pain. To address these issues, authors devised special scalpel to harvest split-thickness costal cartilage grafts. Materials and Methods: Standard inframammary incision was used for harvesting rib. Incision was made directly over the desired rib. Specially designed scalpel was used to cut through the rib cartilage to the half of the thickness. The study was conducted in two parts – cadaveric and clinical. Results: There was significantly less pain and no pneumothorax in the patients in whom the split thickness graft was harvested. Wounds healed without any complication. Discussion: Thus, newly devised angulated scalpel used in the current study, showed the potential to supply the reconstructive surgeon with split thickness rib graft without risk of complications such as pneumothorax or warping contour deformities and post-operative pain

Secondary dentine as a sole parameter for age estimation: Comparison and reliability of qualitative and quantitative methods among North Western adult Indians

The indestructible nature of teeth against most of the environmental abuses makes its use in disaster victim identification (DVI). The present study has been undertaken to examine the reliability of Gustafson’s qualitative method and Kedici’s quantitative method of measuring secondary dentine for age estimation among North Western adult Indians. 196 (M = 85; F = 111) single rooted teeth were collected from the Department of Oral Health Sciences, PGIMER, Chandigarh. Ground sections were prepared and the amount of secondary dentine formed was scored qualitatively according to Gustafson’s (0–3) scoring system (method 1) and quantitatively following Kedici’s micrometric measurement method (method 2). Out of 196 teeth 180 samples (M = 80; F = 100) were found to be suitable for measuring secondary dentine following Kedici’s method. Absolute mean error of age was calculated by both methodologies. Results clearly showed that in pooled data, method 1 gave an error of ±10.4 years whereas method 2 exhibited an error of approximately ±13 years. A statistically significant difference was noted in absolute mean error of age between two methods of measuring secondary dentine for age estimation. Further, it was also revealed that teeth extracted for periodontal reasons severely decreased the accuracy of Kedici’s method however, the disease had no effect while estimating age by Gustafson’s method. No significant gender differences were noted in the absolute mean error of age by both methods which suggest that there is no need to separate data on the basis of gender

Morphology and age-related changes in calcospherites of human teeth: an ultrastructural study

Background: Dentine has been examined extensively for age-related physiological changes, but there are limited data on age-related changes at ultrastructural level of dentine. Aim: The present study aimed to examine age-related ultrastructural changes in calcospherites of human dentine under the scanning electron microscope. Materials and methods: Thirty single rooted teeth of North Western adult Indians (18–75 years) were collected from the Department of Oral Health Sciences, PGIMER, Chandigarh. Labiolingual sections were prepared and morphology of calcospherites was studied at different locations (coronal, cervical, midroot and apical) of the tooth. Results: Morphologically, four types (I [small, unfused and discrete], II [partially fused and globular], III [large, completely fused] and IV [structureless]) of calcospherites were seen in the sample. With advancing age, type I calcospherites approached neighbouring crystals and changed their form to type II, which ultimately coalesced and transformed to type III. Results revealed that among different age groups (young, middle and old), calcospherites of only type I, II and III showed statistically significant differences in their shapes using Pearson’s Chi-square test. Statistically non-significant differences were obtained in the shapes at different locations of the tooth. Conclusions: Results showed that calcospherites get fused as age advances. There is a change in the shape of calcospherites based on the location of the tooth

“Soft that molds the hard:” Geometric morphometry of lateral atlantoaxial joints focusing on the role of cartilage in changing the contour of bony articular surfaces

Purpose: The existing literature on lateral atlantoaxial joints is predominantly on bony facets and is unable to explain various C1-2 motions observed. Geometric morphometry of facets would help us in understanding the role of cartilages in C1-2 biomechanics/kinematics. Objective: Anthropometric measurements (bone and cartilage) of the atlantoaxial joint and to assess the role of cartilages in joint biomechanics. Materials and Methods: The authors studied 10 cadaveric atlantoaxial lateral joints with the articular cartilage in situ and after removing it, using three-dimensional laser scanner. The data were compared using geometric morphometry with emphasis on surface contours of articulating surfaces. Results: The bony inferior articular facet of atlas is concave in both sagittal and coronal plane. The bony superior articular facet of axis is convex in sagittal plane and is concave (laterally) and convex medially in the coronal plane. The bony articulating surfaces were nonconcordant. The articular cartilages of both C1 and C2 are biconvex in both planes and are thicker than the concavities of bony articulating surfaces. Conclusion: The biconvex structure of cartilage converts the surface morphology of C1-C2 bony facets from concave on concavo-convex to convex on convex. This reduces the contact point making the six degrees of freedom of motion possible and also makes the joint gyroscopic