Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241618EnglishN2014September21ANALYSIS OF DROUGHT EFFECT ON ANNUAL STREAM FLOWS OF RIVER MALEWA IN THE LAKE NAIVASHA BASIN, KENYA English0106Marshal M. KyambiaEnglish Benedict M. MutuaEnglishThe main parameters of drought phenomenon are the longest duration and largest severity for a desired return period. These parameters form the basis for designing water storage structures to cope with drought effects. In this study, these drought parameters were estimated using the probability based theory. The sample estimates of the mean, coefficient of variation, skewness, correlation and information on the probability distribution of flow sequence, were used as the basic input parameters. The truncation level was considered at mean level of the annual flow sequences of River Malewa in Lake Naivasha basin. In this basin, 100, 50, 10, 5 and 2-year droughts may persist continuously for 6, 4, 3, 2 and 1 years respectively. From the probabilistic approach for a normal probability distribution function, high values of coefficient of variation resulted in high values of the actual severity. The results show that there is drought severity in Lake Naivasha basin especially in parts experiencing high inter-annual variability in annual flow regimes. EnglishDrought, Severity, Return Period, Probability Theory, Truncation LevelINTRODUCTION In the design, planning and management of water resources, it is necessary to estimate the hydrological drought characteristics under certain return periods. This provides a scientific base for estimating engineering design and water resources utilisation. Changing drought characteristics have affected the function and operation of existing water resources management practices (Below et al., 2007). Adverse effects of hydrological droughts have aggravated the impacts of other stresses, such as population growth, changing economic activities, land-use change and urbanisation (Mogaka et al., 2006; Jahangir et al., 2013). The current water management practices need to be made dynamic so as to cope with the changes in hydrological characteristics which have direct impact on water resources (Wilhite and Easterling, 1997; Svoboda et al., 2002; Abad et al., 2013). Hence, the characteristics of hydrological drought events need to be studied so as to apply the appropriate adaptation and mitigation measures (Mishra et al., 2009). The effects of drought in many activities depend on the severity, duration and geographical extent of precipitation deficiency, and on whether precipitation is used directly to maintain soil moisture or whether water supplies are drawn from the stream flows (Below et al., 2007). Different types of drought have been described, for instance by the World Meteorological Organisation (Subrahmanyan, 1967; Hayes et al., 2011), by Wilhite and Glantz (1985) and also by Zoljoodi and Didevarasl (2013). Of importance among the different types of droughts is the hydrological drought, defined in terms of reduction of stream flows, reduction in lake or reservoir storage, and lowering of ground water levels below a predefined threshold level. Such a threshold level has been termed as the truncation level in hydrological droughts (El-Jabi et al., 2013). This truncation level reflects the demand level for water hence the reason for the examination of this type of drought as presented in the paper. The choice of truncation level is largely governed by the purpose of investigation (Meigh et al., 2002; Sung et al., 2013). Studies have considered it as long term mean flow (Sharma, 1997), while others took it as a percentile level of the flow duration curve ranging from Q50 (flows exceeding 50% of the time) to Q95 (Hisdal and Tallaksen, 2003). A flow duration curve could be constructed based on annual, monthly or daily flow sequences. For example, when the interest is in the design and planning of a water storage system, on a permanent or long-term basis, for ameliorating drought, then a truncation level corresponding to the mean level of flow could result in a conservative design to produce a desirable drought mitigation scenario. In contrast, in regional drought frequency analysis, a value of truncation level such as Q70 or Q80 would portray more tangible drought impacts over the region (Panu and Sharma, 2002). However, in shortterm contingency planning for drought amelioration, when drought impacts are tangible, drought investigation could even be carried out at a truncation level of Q90, to allow mobilisation of resources on a cost- effective basis. There are two principal methods for predicting the duration and severity of droughts associated with return period. In the time series simulation approach, the simulated stream flow is truncated at the desired level. The drought episodes (runs of deficits) are analysed empirically using the theory of runs or through counting technique (Chung and Salas, 2000). For instance, Horn (1989) successfully used this approach to describe the behaviour of droughts in Idaho, USA. In the probability theory-based approach, the properties of a drought, including the length (duration) and depth (severity) are derived from basic axioms of probability. This approach enables estimates of length of the longest run and associated greatest severity for a desired return period (Sharma, 1997). This approach requires information on the underlying probability distribution of the stream flow series. This method was adopted in this study because it can be computed using the drought probability (q) and return period (T). The main objective of this study was to determine the critical parameters of hydrological drought using the probability based theory. MATERIALS AND METHODS Study area The Lake Naivasha basin which is approximately 3376 km2 , is located in the Kenyan Rift Valley and it is approximately 70 km from the Kenyan capital city, Nairobi. The maximum altitude is about 3990m above mean sea level (a.m.s.l) on the eastern side of the Aberdare ranges to a minimum altitude of about 1900m (a.m.s.l). There are two rainy seasons experienced in this basin with the long and short rains occurring in March to May and October to November respectively. The Lake Naivasha basin receives an average annual rainfall of 610 mm, with the wettest slopes of the Aberdare ranges receiving as much as 1525 mm per annum. The lake is fed by two main perennial rivers namely; the Malewa and Gilgil. The River Malewa (Figure 1) with a catchment area of 1600km2 is the major river feeding the lake, contributing about 90% of the total discharge into the lake (Lukman, 2003). Due to the difference in altitude, diverse climatic conditions exist within the Lake Naivasha basin. Data Acquisition To analyse hydrological droughts in the River Malewa, the daily flow data at the gauging station 2GB1 were acquired from Water Resources Management (WRMA) Naivasha regional office. The 2GB1gauging station was chosen since it had uninterrupted streamflow data records for over 50 years (from 1959-2008). Prior to trend analysis, the hydrological records were tested for homogeneity and normality. Homogeneity of time series records is confirmed when observed variations result entirely from fluctuations in weather and climate. Testing for homogeneity was done to find out if or not there were any errors that could have resulted from gauge station and environmental changes (Wijngaard et al., 2003). The non-parametric Pettit’s test (Mann, 1945; Mann and Whitney, 1947; Petti, 1979; Libiseller and Grimvall, 2002) was used to check for the homogeneity of the time series records. Evaluation of Extreme Drought Severity based on Drought Duration and Intensity The length of a drought spell and its associated sever ity for a given return period were calculated using the probability based analytical relationships. The theorem of extremes of random variables using q and r provided a basis for derivation E(LT ) and E(ST ) relationships. Any uninterrupted sequence of deficits below the mean flow was regarded as drought length equal to the number of deficits in the sequence. This was carried out at gauging station 9036002 on River Malewa which is the main river draining the basin and feeding Lake Naivasha. Critical Drought Duration, E(LT ) and Severity E(ST ) In order to identify the underlying probability of the annual stream flow and their dependence structure, natural flow sequences were used in the analysis. The values of µ, γ, ρ, σ and cv were computed using the standard procedure as documented in Chow et al. (1988). For a time series xi truncated at a level x0 , the truncation level m0 is equal to ( x0 m) σ − , Further, if x is normally distributed, so would be u. Thus, for a normally distributed sequence, u will be written as a standard normal deviate (z) and the probability:   For instance, the value of q at a truncation level equivalent to the mean level for a normal probability distribution of flow sequence is 0.5, which can be integrated from the above standard normal probability function from -∞ to 0 . For a flow sequence with a coefficient of variation of cv and the truncation level at Tl of the mean flow, the value of u0 = z0 = . In this study, the value of q was obtained by using standard probability tables. The probabilistic relationship for and was obtained by applying the theorem of extremes of random variables as applied by Sharma (2000) and Biamah et al. (2005) as expressed in equations (2) and (3). (2) (3) Where, j stands for the length of the drought duration and takes on values 1, 2, 3,…, up to infinity. In this study, the value of j was considered at a maximum of 25, as probabilities beyond j >25 are extremely small and can be regarded negligible. Equation (3) thus was expressed as: (4) The value of r, representing an extended continuance of drought years, was related to q, as shown by Sen (1977): (5) Where, v is a dummy variable for integration. The integral in equation (5) was evaluated using excel spreadsheet and values of r for a given q and z0 were computed. For an independent or random stream flow series r = q and a value of drought intensity I was estimated using a formula by Sharma (2000): (6) The value of I in equation (6) turned out to be negative (since drought epochs are below the truncation level and hence negative in terms of sign); therefore absolute values were used in the calculation of the severity defined as: (7) It is noted that, when the analysis is implemented in the standard domain, and are all dimensionless and without units. Thus, the actual drought severity was computed using the relationship which results to: RESULTS AND DISCUSSION Evaluation of Extreme Drought Severity based on Duration and Intensity The probabilistic approach was used to estimate the duration and severity of a T-year drought on historical data of annual flows. The truncation was at the mean level of the gauging station 2GB1 in Lake Naivasha basin. For the probabilistic approach, the assumption that annual flow sequences are normal and independent was a reasonable choice for analysis, since ρ and γ happen to be insignificantly small. This is because, this assumptions yields marginally conservative values of severity which is a desirable feature for design aspects of water resources systems for ameliorating drought conditions. The value of zo is 0.0 for the truncation level equal to the mean flow, and the corresponding value of q is 0.5 as given in Table 1. For a flow sequence, the value of r = q = 0.5 indicates that flows are random and, consequently, the drought episodes are also random. By using the values of zo , q, r and T = (2, 5, 10, 50 and 100 years) in equations (2) to (7), the values of LT, I and ST were calculated and their results are presented in Table 2. The Table also presents results of the values of DT for different return periods that were calculated using equation (8). From the results given in Table 2, it can be observed that on average, the 100-year drought in Lake Naivasha basin is expected to last for 6 years in a row and with a corresponding severity of 4.78. Similarly, the 2, 5, 10 and 50-year droughts are expected to last for 1, 2, 3 and 4 years respectively with the drought lengths rounded off to a whole year. All these computations were done using the MS Excel spreadsheet and the summary of the computations for a 10-year drought is presented in Table 3. For any desired design return period, the important elements of a drought phenomenon considered are the longest duration and the largest severity (Sharma, 1998). These elements form the basis for designing water storage structures to cope with droughts for adaptation planning to climate variability. It is evident from the probabilistic approach for a normal probability distribution that high values of cv result in high values of DT. Based on this, drought severity is expected to be greater in the basin parts experiencing high inter-annual variability in annual flow regimes. Such occurrences will be common in the semi-arid regions of the Lake Naivasha basin which routinely experience variable precipitation patterns. The values of drought duration for normal independent flows were predicted using two independent variables, T and q. The results show that critical droughts will persist for the same number of years in the entire Lake Naivasha basin. Likewise, standardized severity is also expected to be the same in the entire basin. However, each river will undergo a different level of actual severity DT (m3 ), because of different values of mean flows and associated coefficient of variation. These results have a significant implications pertaining to future water resources planning in the Lake Naivasha basin, especially against the backdrop of a higher likelihood of multi-year droughts due to climate variability. This risk must be considered in planning, design, operation and selection of water resources development scenarios in the Lake Naivasha basin. In particular, when attention is being focused on developing the lower parts of the basin, planners have to appreciate the fact that this region is very prone to droughts, unlike the abundantly water-rich upper parts of the basin near the Aberdare forest. CONCLUSIONS The overall objective of the study was to analyze hydrological drought characteristics with a view to providing information for planning local coping mechanisms to water resources management. The critical drought parameters, namely the longest drought duration and the greatest severity were predicted using the probability based approach. The analysis revealed that the annual stream flow sequences can be construed as samples from the normal independent flow sequences. The probabilistic analysis of drought revealed that, in the prevailing hydrological regimes, 100-year, 50-year, and 10-year droughts will persist for 6, 4 and 3 years respectively. The longest drought duration and severity have uniform values for the entire study area in view of the normal and random probability structure of annual flows. However, actual severity will display variability in proportion to the coefficient of variation or standard deviation. These results can be applied in the design of water storage systems to combat the persistent extreme hydrological drought. This study was important because it has enhanced the understanding of hydrological drought characteristics, which can be used to enhance water sources management within Lake Naivasha basin. ACKNOWLEDGEMENT The authors would like to appreciate the support that they received from the Water Resources Management Authority (WRMA) Naivasha, during the field work and data collection. In addition, the authors do appreciate the support from the Faculty of Engineering and Technology, Egerton University. In addition, the authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this paper. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Englishhttp://ijcrr.com/abstract.php?article_id=756http://ijcrr.com/article_html.php?did=756Abad MBJ, Zade AH, Rohina A, Delbalkish H, Mohagher SS. The effect of climate change on flow regime in Bashar River using two meteorological and hydrological standards. International Journal of Agriculture and Crop Sciences 2013; 5: 2852-2857. Below R, Grover-Kopec E, Dilley M. Documenting drought related disasters. A global reassessment. J Environ Dev 2007; 16:328–344. Biamah EK, Sterk G, Sharma TC. Analysis of agricultural drought in Iiuni, Eastern Africa: application of a Makov Model. Hydrol. Processes 2005; 19(5): 1307-1322. Chow VT, Maidment DR, Mays LW. Applied Hydrology. McGrawHill, New York 1988. Chung CH, Salas JD. Drought occurrence probabilities and risks of dependent hydrologic processes. J. Hydrologic Engrg, ASCE 5 2000; (3): 259–268. El-Jabi N, Noyan T, Daniel C. Regional Climate Index for Floods and Droughts Using Canadian Climate Model (CGCM3.1). American Journal of Climate Change 2013; 2(2): 1-10 DOI:10.4236/ajcc.2013.22011. Hayes M, Svoboda M, Wall N, Widhalm M. The Lincoln declaration on drought indices: universal meteorological drought index recommended. Bull Am Meteorol Soc 2011; 92:485–488. Hisdal H, Tallaksen LM. Estimation of regional meteorological and hydrological drought characteristics: a case study of Denmark. J. Hydrol 2003: 281: 230-247. Horn DR. Characteristics and spatial variability droughts in Idaho. J. Irrg. Drain Engng Div. ASCE 1989; 115(1): 111-124. Jahangir ATM, Sayedur RM, Saadat AHM. Gamma Distribution and its Application of Spatially Monitoring Meteorological Drought in Barind, Bangladesh. International Journal of Geomatics and Geosciences 2013; 3(3): 511-524. Libiseller C, Grimvall A. Performance of partial Mann-Kendall test for trend detection in the presence of covariates. Environmetrics 2002; 13: 71–84. Lukman AP. Regional Impacts of Climate Change and Variability of Water Resources (Case study of Lake Naivasha basin, Kenya) [dissertation]. International Institute for Aerospace Survey and Earth science, Enschede, The Netherlands; 2003. Mann HB, Whitney DR. On a test of whether one of two random variables is stochastically larger than the other. Ann Math Stat 1947; 18: 50–60. Mann HB. Non-parametric test against trend. Econometrika 1945; 13: 245–259. Meigh JR, Tate EL, McCartney MP. Methods for identifying and monitoring river flow drought in Southern Africa. In proc. Lukman AP. Regional Impacts of Climate Change and Variability of Water Resources (Case study of Lake Naivasha basin, Kenya) [dissertation]. International Institute for Aerospace Survey and Earth science, Enschede, The Netherlands; 2003. Mann HB, Whitney DR. On a test of whether one of two random variables is stochastically larger than the other. Ann Math Stat 1947; 18: 50–60. Mann HB. Non-parametric test against trend. Econometrika 1945; 13: 245–259. Meigh JR, Tate EL, McCartney MP. Methods for identifying and monitoring river flow drought in Southern Africa. In proc.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241618EnglishN-0001November30AN ANATOMICAL STUDY ON LOCATION OF MAXILLARY SINUS OSTIUM AND IT' S SURGICAL IMPORTANCE English0709Jyothi N. NayakEnglish Varalakshmi K. L.English Sangeetha M.English Shilpa NaikEnglishBackground: A clear knowledge of exact location of maxillary sinus openings is essential for the endoscopic sinus surgeons as it is related to important structures like orbital floor, ethmoidal infundibulum and the nasolacrimal duct. Aim: The principle maxillary ostium is opened in the hiatus semilunaris which is located on the upper part of medial wall of maxillary inus. Materials and Methods: This study was carried in 52 sagitally cut head and neck specimens from the Department of anatomy, MVJ Medical College and Research Hospital. RESULT: In the present study, maxillary sinus ostium was more commonly opened in to the posterior third of the hiatus semilunaris in 33(63.46%) specimens, middle third of hiatus semilunaris in 13(25%) specimens, anterior third in 5(9.61%) and absent in 1 (1.9%)specimens. Accessory maxillary ostium was found in 6(18.75%) specimens, which opened into the membranous meatus inferior to the uncinate process. Conclusion: This study will be helpful for surgeons to prevent the complications while performing endoscopic sinus surgery. EnglishAccessory maxillary ostium, Ethmoidal infundibulum, Hiatus semilunaris, Nasolacrimal duct, Principal maxillary ostiumINTRODUCTION Evolution is a gradual process due to which man attained erect posture whereby the principal or main maxillary ostium came to be located at a higher level because of that the drainage was no longer due to gravity. This factor along with the improper mucociliary action of the lining mucosa is the main cause of the obstruction of ostium which opens at the hiatus semilunaris[1] .The osteomeatal complex refers to the common drainage pathway of the frontal, maxillary, anterior and middle ethmoidal sinuses[2]. The maxillary sinus ostium drains into the infundibulum which joins the hiatus semilunaris and drains into the middle meatus. A possible mechanism of formation of accessory ostia is obstruction of the primary ostium by maxillary sinusitis or due to anatomic and pathologic factors in the middle meatus which results in the rupture of membranous areas known as fontanelle[1] . The ostium of maxillary sinus is located on the highest part of the medial wall of the sinus which is responsible for poor free drainage and it opens in to the narrow ethmoidal infundibulum instead of direct opening into the nasal mucosa, so the inflammation of its surrounding area can further interfere with drainage[3]. So the Osteomeatal unit is a critical area for the Functional endoscopic sinus surgery. The surgical interventions of the functional endoscopic sinus surgery is designed to remove the blockage of maxillary sinus ostium and to retain the normal sinus ventillation and mucociliary function[4].Considering the surgical importance of location of maxillary sinus ostium,the present study is an attempt to learn the exact location, presence of accessory / absence of maxillary ostium. MATERIAL AND METHODS Fifty two sagitally cut head and neck specimens were taken from the department of anatomy of MVJ Medical College and Research Hospital. In each specimen middle concha was cut or reflected along its margins and middle meatus was opened. The specimens were washed properly and then a probe is introduced to observe the location of sinus ostium and direction of opening. The presence of accessory maxillary ostium is also noted. The percentages of different locations of sinus ostium were calculated. RESULTS The principal maxillary ostium was found at the junction of medial maxillary wall and the floor of the orbit, halfway between the anterior and posterior maxillary walls. The maxillary ostium was oval shaped or slit like and oriented horizontally or obliquely. The position of the maxillary sinus ostium in 52 half heads was as follows. • In 33 specimens, maxillary sinus ostium was located in the posterior 1|3 of hiatus semilunaris. • In 13 specimens, maxillary sinus ostium was located in the middle 1|3 of hiatus semilunaris. • In 5 specimens, the maxillary sinus ostium was located in anterior 1|3 of hiatus semilunaris. • In 1 specimen the maxillary sinus ostium was absent. • Accessory maxillary ostia were found in 6 specimens DISCUSSION The maxillary sinus formed from outgrowths or diverticula of the walls of the nasal cavities and become pneumatic extensions of the nasal cavities of maxillae. The original openings of the diverticula persist as the primary maxillary sinus ostium[5]. The primary maxillary ostium may be found at any point along the course of infundibulum. In the present study , maxillary sinus ostium was more commonly found to open into the posterior third of the infundibulum in 33(63.46%) specimens, while it was opened in to the middle third in 13(25%) and anterior third in 5(9.61%) specimens.(Table1). Prasanna reported similar observations and found the opening of maxillary ostium into the anterior 1/3 of hiatus semilunaris in 4(10%), the middle third in 11(27.5%) and the posterior third in 21(52.5%) cases[4]. Van Alyea also reported the openings of maxillary ostium into the posterior third of uncinate groove in 71.8% cases[6]. Rosenberger has stated that maxillary ostium opens into the posterior third in 70% cases. Thus maxillary ostium commonly opens into the posterior third of the uncinate groove [3]. Myerson recognised that the ostium of the maxillary sinus is located immediately below the orbital floor, and thus below the lamina papyracea in the posterior part of the infundibulum, and that perforating the lateral wall of the infundibulum superior to the ostium violates the orbit. Hence the sinus surgeon must have a thorough knowledge of the relevant relationship to avoid injury to the orbit. Blind probing or nibbling with the forceps may lead to higher incidence of orbital complications [7] Maxillary accessory ostium is one of the anatomical variations that may play a role in the development of chronic maxillary sinusitis. The incidence of accessory maxillary ostium has been recorded from to range from 0 to43%.In the present study accessory maxillary ostia were found in 6(18.75%) specimens. Similar observations were earlier noted by Van Alyea in 23%, Myerson in 30.7%, Prasanna in 22.5%, and Manju Singhal in 18.5%. Manju and Kennedy reported their presence either in the Anterior nasal fontanelle or Posterior nasal fontanelle[8]. May et al found their presence restricted to the Posterior nasal fontanelle posteroinferior to the natural ostia[9]. Van Alyea reported in his study that the natural ostia were easily accessible in 40% of specimens, but that in 20% the ostia could not be cannulated because of the anatomic configuration of the uncinate process or the bulla or the size of the ostia. In the remainder of the specimens, cannulation was only possible because of the skill, experience of the surgeon or because an accessory ostium was present[6]. Clinically the Accessory maxillary ostium may be utilized in such cases by the endoscopic sinus surgeons to irrigate the maxillary sinus. Apart from the ostia the fontanelles may be used to create alternative passage which re-establishes ventilation and drainage during therapy of maxillary sinusitis [10]. CONCLUSION The detailed anatomical knowledge of variations in the location of maxillary sinus ostium and accessory ostium is important for endoscopic sinus surgeon in order to perform the middle meatal antrostomy as well as for radiologists for proper interpretation of x rays. The exact localisation of sinus ostium is also important in case of stenosis for proper dilatation of ostium without any complications. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Englishhttp://ijcrr.com/abstract.php?article_id=757http://ijcrr.com/article_html.php?did=7571. Kumar H, Choudhry R, Kakar S. Acessory maxillary ostia: Topography and clinical application. Journal of Anatomical Society India .2001; 50(1):3-5. 2. Manju D. Singhal and Deepak Singhal. Maxillary Sinus Ostium – Morphology and it’s Clinical Relevance.2013; 2 (3): pp. 26-29. 3. Hollinshed WH, Rosse C. Text book of Anatomy, 4th edition. Herper and Row, Philadelphia.1985; pp 976-985. 4. L C Prasanna and H Mamatha .The Location of Maxillary Sinus Ostium and Its clinical Application. Indian Journal of Otolaryngology and Head and Neck Surgery.2010; 62(4):335- 337. 5. Moore K L and Persaud TVN. The Developing Human. Saunders Elsevier; Philadelphia, Pennsylvania.2003; 227- 228. 6. Van Alyea OE. The ostium maxillare. Anatomic study of its surgical accessibility. Arch Otolaryngology.1936; 24:553- 569. 7. Myerson The natural orifice of maxillary sinus, anatomical studies, Archives of Otolaryngology.1932; 5 80-91. 8. Manju D Singhal and Deepak Singhal. Anatomy of Accessory Maxillary Sinus Ostium with Clinical Application International Journal of Medical Science and Public Health.2013; Vol 3, 327-329. 9. MayM, Scbol SM, Korzee J .Location of maxillary ostium and its importance to the endoscopic sinus surgeons.Laryngoscope.1990; 100, 1037-42. 10. Levine HL, Mark M, Rontal M, Rontal E. Complex anatomy of lateral nasal wall simplified for endoscopic surgeon Endoscopic sinus surgery. Thieme medical Publishers, New York.1993; pp 1-28.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241618EnglishN2014September21A MORPHOMETRIC STUDY OF THE PEDICLES IN DRY HUMAN TYPICAL THORACIC VERTEBRAE English1015Dhaval K. PatilEnglish Pritha S. BhuiyanEnglishBackground: Pedicle screw fixation in the thoracic spine remains a technical challenge. Knowledge of the pedicle diameter and chord length is essential for choosing the appropriate pedicle screw, whereas the pedicle angle is important for accurate screw lacement. Objective: To measure the various dimensions of pedicles in typical thoracic vertebrae. Material and methods: Two hundred dry human typical thoracic vertebrae of undetermined gender and age were selected for the study. The various parameters of pedicles were measured. Results: The mean pedicle width at the midpoint of the pedicle on the left was 4.33 ± 1.03 mm and on the right side was 4.29 ± 0.97 mm. The mean pedicle height at the midpoint of the pedicle on the left side was 10.54 ± 1.17 mm and on the right side was 10.6 ± 1.1 mm. The mean transverse pedicle angle on the left side was 14.37 ± 5.25 degrees and on the right side was 14.52 ± 5.3 degrees. The mean sagittal pedicle angle on the left side was 13.81 ± 3.27 degrees and on the right side was 13.82 ± 3.26 degrees. The mean chord length on the left was 35.94 ± 3.94 mm and on the right side was 35.83 ± 3.97 mm. Conclusion: Thus, a comprehensive data set has been presented which will help in development of pedicle instruments for Indian population. EnglishTypical thoracic vertebra, Pedicle width, Pedicle angle, Chord lengthINTRODUCTION Vertebral column morphology is influenced externally by mechanical and environmental factors and internally by genetic, metabolic and hormonal factors. These all affect its ability to react to the dynamic forces of everyday life, such as compression, traction and shear. These dynamic forces can vary in magnitude and are much influenced by occupation, locomotion and posture1. Thus, the vertebrae can be involved in various conditions such as developmental anomalies, injuries, infections and tumours. In recent years there have been considerable developments in instrumentation designed to stabilize and correct the thoracic and lumbar spine in various clinical disorders. Transpedicular screw insertion has been a popular method for spinal fixation at the level of lumbar vertebrae. However, its use in the thoracic vertebrae remains restricted due to the technical and anatomical pitfall. Use of wrong size of screw may result in cortex perforation of pedicle or fracture of pedicle with resultant injury to nerve roots. According to McLain RF et al2, the longest screw with the largest thread area and thickest minor diameter will provide the best pullout strength and the best screw bending resistance. The present study was conducted to define morphometric characteristics of the thoracic pedicle in an Indian population and compare our data with the other studies. MATERIAL AND METHODS The study was conducted on dry human typical thoracic vertebrae. The vertebrae were obtained from the bone collection of the department of Anatomy of a tertiary care hospital. Of the total collection of thoracic vertebrae in the department, 200 undamaged typical thoracic vertebrae were selected for the study. The vertebrae were of undetermined gender and age. Each vertebra was assigned a serial number. Anatomical measurements were taken on these specimens using a vernier caliper (0-150mm with a precision of 0.02 mm). The vertebrae were photographed with a digital camera and the angular measurements were recorded using MB ruler software. MB ( Markus-Bader ) ruler is a software which is free to use for non-commercial purposes.3 (Fig. 1-2). The following parameters were recorded in a proforma: Pedicle width at the midpoint of the pedicle- It is the distance between medial and lateral surfaces of pedicle at its midpoint, measured at right angles to the long axis of the pedicle. (Fig. 3) Pedicle height at the midpoint of the pedicle- It is the vertical distance between superior and inferior border of pedicle at its midpoint. Transverse pedicle angle- It is the angle between a line passing through the pedicle axis and a line parallel to the vertebral midline in the transverse plane. (Fig. 4) Sagittal pedicle angle- It is the angle between a line passing through the pedicle axis and superior vertebral body border in the sagittal plane. Chord length (Screw path length) - It is the distance from the most posterior aspect of the junction of the superior facet and the transverse process to the anterior cortex of the vertebral body along the pedicle axis. RESULTS The pedicle width at the midpoint of the pedicle on the left side ranged from 1.96 - 7.96 mm with a mean of 4.33 ± 1.03 mm and on the right side ranged from 1.98 - 8.02 mm with a mean of 4.29 ± 0.97 mm. The pedicle height at the midpoint of the pedicle on the left side ranged from 7.14 - 13.42 mm with a mean of 10.54 ± 1.17 mm and on the right side ranged from 7.18 - 13.56 mm with a mean of 10.6 ± 1.1 mm. The transverse pedicle angle on the left side ranged from 5.11 - 28.14 degrees with a mean of 14.37 ± 5.25 degrees and on the right side ranged from 5.55 - 29.93 degrees with a mean of 14.52 ± 5.3 degrees. The sagittal pedicle angle on the left side ranged from 4.71 - 22.07 degrees with a mean of 13.81 ± 3.27 degrees and on the right side ranged from 5 - 21.57 degrees with a mean of 13.82 ± 3.26 degrees. The chord length on the left side ranged from 26.64 - 47.28 mm with a mean of 35.94 ± 3.94 mm and on the right side ranged from 26.8 - 47.34 mm with a mean of 35.83 ± 3.97 mm. DISCUSSION Several quantitative anatomical studies have been carried out for thoracic vertebrae in different countries. Many authors have studied the pedicles of vertebrae using different methods such as computed tomography (CT) scans, Magnetic Resonance Imaging (MRI) scans, plain radiographs, direct specimen measurements and quantitative 3-dimensional anatomic techniques. The following tables present the comparison of means of the various parameters obtained from previous studies with that of the present study. 1. PEDICLE WIDTH AT THE MIDPOINT OF THE PEDICLE (Table 1) Pedicle width is important as it determines the diameter of screw that can be accommodated safely in a pedicle without breaching its medial and lateral cortex. Pai BS et al4 noted that the pedicle width ranged between 3.5 - 7.9 mm for typical thoracic vertebrae as compared to 1.96 - 8.02 mm in the present study. 2. PEDICLE HEIGHT AT THE MIDPOINT OF THE PEDICLE (Table 2) Pedicle height also influences pedicle screw selection. However, in all studies, it has been established that the pedicle height is always greater than the pedicle width. The present study agrees with this finding. Thus, from a practical point of view, pedicle height carries lesser importance in deciding pedicular screw diameter. According to Pai BS et al4, the pedicle height ranged between 6 - 14.3 mm for typical thoracic vertebrae as compared to 7.14 - 13.56 mm in the present study. 3. TRANSVERSE PEDICLE ANGLE (Table 3) Knowledge of transverse pedicle angle is important while placing screws because any inadvertent medial perforation due to wrong placement of the pedicle screw can put the spinal cord at risk or cause vascular injury. According to Table 3, the mean transverse pedicle angle in the present study is in correspondence with that of Berry JL et al5, Roop Singh et al11 and Pai BS et al4. 4. SAGITTAL PEDICLE ANGLE (Table 4) Sagittal pedicle angle is important in accurate screw placement as inferior migration of the screw may result in injury to the nerve root. Table 4 indicates that the mean sagittal pedicle angle in the present study is greater than the findings of Datir SP et al8 and Panjabi MM et al7 but smaller than those of Shiu-Bii Lien et al10, Roop Singh et al11 and Zindrick MR et al6. 5. CHORD LENGTH (SCREW PATH LENGTH) (Table 5) Chord length determines the safest length of any screw that can be used for pedicular fixation. It is important in preventing anterior cortex perforation and therefore consequent injury to vital organs and major blood vessels which lie anterior to the vertebral body. Table 5 indicates that the mean chord length in the present study is lesser than the values of the study by Pai BS et al4 and McLain RF et al2 and is greater than that of Datir SP et al8, Tan et al9 and Roop Singh et al11. Pai BS et al4 noted the range of chord length for typical thoracic vertebrae as 26.1 - 49.9 mm as compared to 26.64 - 47.34 mm in the present study. CONCLUSION Thus, a comprehensive data set has been presented which provides quantitative anatomy of pedicles of typical thoracic vertebrae. The differences in the results of the present study and those of the previous studies with respect to some of the parameters may be due to differences in race, ethnicity, environmental factors as well as methods used for the studies. These findings strengthen the recommendations by Roop Singh et al11 for modification in spinal surgery instrumentations (screw/hooks/cages) in accordance with the morphometric data obtained from Indian population. In the future, the scope of the study can be further extended to study the vertebral column with respect to individual vertebral levels. ACKNOWLEDGEMENTS Authors acknowledge, Dean, Seth G. S. Medical College and K.E.M. Hospital, Mumbai and all staff members and colleagues from Department of Anatomy, Seth G. S. Medical College, Mumbai. Authors also acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Englishhttp://ijcrr.com/abstract.php?article_id=758http://ijcrr.com/article_html.php?did=758Standring S. The Back. In: Newell RL, editor. Gray’s Anatomy: Anatomical Basis of Clinical Practice. 40th ed. Edinburgh: Elsevier Churchill Livingstone; 2008: 712-724 McLain RF, Ferrara L, Kabins M. Pedicle morphometry in the upper thoracic spine: limits to safe screw placement in older patients. Spine (Phila Pa 1976) 2002; 27: 2467-2471 Markus-bader.de [Internet]. [Place unknown]: MB-Softwaresolutions; c2013. MB-Ruler - the triangular screen ruler. Available from: http://www.markus-bader.de/MB-Ruler/ index.php Pai BS, Gangadhara, Nirmala S, Muralimohan S, Varsha SM. Morphometric analysis of the thoracic pedicle: An anatomico-radiological study. Neurol India [Internet]. 2010; 58: 253-8. Available from: http://www.neurologyindia.com/text. asp?2010/58/2/253/63808 Berry JL, Moran JM, Berg WS, Steffee AD. A morphometric study of human lumbar and selected thoracic vertebrae. Spine (Phila Pa 1976) 1987; 12: 362-367 Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine (Phila Pa 1976) 1987; 12: 160-166 Panjabi MM, Takata K, Goel V, et al. Thoracic human vertebrae: quantitative three-dimensional anatomy. Spine (Phila Pa 1976) 1991; 16: 888-901 Datir SP, Mitra SR. Morphometric study of the thoracic vertebral pedicle in an Indian population. Spine (Phila Pa 1976) 2004; 29: 1174-1181 Tan SH, Teo EC, Chua HC. Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans. Eur Spine J. 2004; 13: 137-146 Lien S, Liou N, Wu S. Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Eur Spine J. 2007; 16(8): 1215-1222 Singh R, Srivastva S, Prasath C, Rohilla R, Siwach R, Magu N. Morphometric measurements of cadaveric thoracic spine in Indian population and its clinical applications. Asian Spine Standring S. The Back. In: Newell RL, editor. Gray’s Anatomy: Anatomical Basis of Clinical Practice. 40th ed. Edinburgh: Elsevier Churchill Livingstone; 2008: 712-724 McLain RF, Ferrara L, Kabins M. Pedicle morphometry in the upper thoracic spine: limits to safe screw placement in older patients. Spine (Phila Pa 1976) 2002; 27: 2467-2471 Markus-bader.de [Internet]. [Place unknown]: MB-Softwaresolutions; c2013. MB-Ruler - the triangular screen ruler. Available from: http://www.markus-bader.de/MB-Ruler/ index.php Pai BS, Gangadhara, Nirmala S, Muralimohan S, Varsha SM. Morphometric analysis of the thoracic pedicle: An anatomico-radiological study. Neurol India [Internet]. 2010; 58: 253-8. Available from: http://www.neurologyindia.com/text. asp?2010/58/2/253/63808 Berry JL, Moran JM, Berg WS, Steffee AD. A morphometric study of human lumbar and selected thoracic vertebrae. Spine (Phila Pa 1976) 1987; 12: 362-367 Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine (Phila Pa 1976) 1987; 12: 160-166 Panjabi MM, Takata K, Goel V, et al. Thoracic human vertebrae: quantitative three-dimensional anatomy. Spine (Phila Pa 1976) 1991; 16: 888-901 Datir SP, Mitra SR. Morphometric study of the thoracic vertebral pedicle in an Indian population. Spine (Phila Pa 1976) 2004; 29: 1174-1181 Tan SH, Teo EC, Chua HC. Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans. Eur Spine J. 2004; 13: 137-146 Lien S, Liou N, Wu S. Analysis of anatomic morphometry of the pedicles and the safe zone for through-pedicle procedures in the thoracic and lumbar spine. Eur Spine J. 2007; 16(8): 1215-1222 Singh R, Srivastva S, Prasath C, Rohilla R, Siwach R, Magu N. Morphometric measurements of cadaveric thoracic spine in Indian population and its clinical applications. Asian Spine J. 2011; 5(1): 20-34

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241618EnglishN2014September21STUDY ON ORIGIN, COURSE, BRANCHING PATTERN AND MORPHOMETRY OF SPLENIC ARTERY AND ITS BRANCHES SUPPLYING THE SPLEEN-A CADAVERIC STUDY English1623GangadharaEnglish Rajasekhar P.English Hemasankar C.EnglishObjectives: 1.To measure the length of splenic artery and its branches supplying the spleen till they enter the hilum. 2. To note the origin and course of the splenic artery. 3. To note type of branching pattern of the splenic artery and occurrence of polar artery. Methods: Splenic artery & its branches supplying spleen were dissected neatly, traced till the hilum and measured with the digital vernier calliper. Other branches of splenic artery were not considered in the study. Results: Mean length of the splenic artery trunk was 7.45cms (Range: 2-11cm), lobar artery 3.24cms (Range: 1.2-8cms), segmental artery 1.21cms (Range: 0.4- 3cms), trabecular artery 0.59cm (Range: 0.3-2.5cms). The splenic artery trunk was bifurcated in 80 %( 24), trifurcated in 16.66 % ( 5) and quadrifurcated in 3.3 %( 1). Lobar artery was bifurcated in 63.33%, trifurcated in 33.33% and quadrifurcated in 3.33%. Segmental artery was bifurcated in 93.33% and trifurcated in 6.66%. In All the specimens the splenic artery was arising from coeliac trunk. 63.3 %( 19) of specimens showed supra-pancreatic course and 36.6 % (11) showed retro-pancreatic course of splenic artery. 26.6 %( 8) of specimens showed only superior polar artery, 36.6 %( 11) showed only inferior polar artery, 16.6 %( 5) showed both polar arteries and 20 %( 6) of specimens has no polar artery. Conclusions: knowledge of vascular supply for the spleen is very important for the surgeons during partial resections of spleen and it is also important for radiologist for performing preoperative arteriography and splenic artery embolization.. EnglishSpleen, Splenic artery, Splenic segments, Partial splenectomy, Splenic artery thromboembolismINTRODUCTION The spleen is exclusively supplied by the splenic artery. This is the largest branch of coeliac axis and its course is among the most tortuous in the body. It runs along the superior border of the pancreas in the posterior aspect of the border. It runs as multiple loops or coils. The splenic artery lies anterior to the left kidney and left suprarenal gland. It runs in through splenorenal ligament posterior to the tail of the pancreas and divides in to two or three main branches before entering the hilum of spleen. These branches enter the hilum and they divide further into four or five segmental arteries. These vessels each supply a segment of the splenic tissue. There is little collateral circulation between the segments which means that occlusion of a segmental vessel often leads to infarction of part of the spleen1 . Once the thought was spleen had no major role in sustaining life, but now it is known that the two most important activities of spleen in humans. The phagocytic and immune, derive from its peculiar structure, when it comes to its cellular composition and richness of its irrigation. The spleen cells belong to the lymphoid tissue and to the mononuclear phagocyte system2 . Now a days spleen preserving surgeries like partial splenectomy, segmental resection are upcoming procedures because the spleen is very important to lead infections free life. Therefore the Knowledge of extra parenchymal branching pattern of splenic artery, different levels of its division and their measurements, especially of length of terminal branches/ trabecular arteries/ polar arteries which in other way denotes distance of artery from visceral surface of spleen is very important for surgeons/ radiologists to perform devascularisation of particular part of the spleen to perform partial splenectomy so that, spleen can be preserved3 . Intrasplenic avascular demarcation between the segments is yet to be found perfectly, so that the partial splenectomy can be done with minimal blood loss, and methods for normal functioning of retained spleen after partial resection is yet to be found. MATERIALS AND METHODS 30 cadavers which were embalmed properly using 10% formalin solution, following standard technique were used for the study. The splenic artery was exposed during routine dissection for the 1st MBBS students in the dissection hall, department of anatomy PESIMSR, Kuppam over a period of 3 years. The artery was exposed after cutting the greater omentum and lifting the stomach as a whole. Meticulous dissection was done to separate the celiac trunk from its surrounding dense nerve plexus. The splenic artery was identified which was arising from celiac trunk in all the cases. The artery was traced down from its origin till its branches enter in to the hilum of spleen. The artery was separated from the pancreas, adjacent structures and ligaments for the clear view. All other branches of splenic artery were identified which were cut and separated. The artery and its branches concerned with supplying only spleen were painted with red enamel paint from its origin, till its branches enters into the hilum of the spleen, dried and later photographed immediately. The following parameters were studied: 1. The length of the trunk of splenic artery from its origin from celiac trunk till its branching into primary branches/ lobar arteries 2. Length of the primary branch/lobar artery from its origin till it divides into secondary/segmental arteries 3. Length of the secondary/segmental artery from its origin till it divides into tertiary/sub segmental/ trabecular artery at the hilum of spleen 4. Length of the tertiary/sub segmental/trabecular artery from its origin till it enters into the splenic substance 5. Branching pattern of splenic artery trunk, lobar artery, segmental artery and trabecular artery 6. Percentage of occurrence of lobar artery, segmental artery and trabecular artery 7. Origin of splenic artery 8. Type of Course of the splenic artery 9. Percentage of occurrence of polar artery Measurements were done by using the digital vernier callipers and immediately noted in the preformed proforma. The rough outline of the branching pattern in each specimen was drawn separately on the paper immediately and preserved for further reference and noted the length of splenic artery, lobar artery, segmental artery and trabecular artery on the sketch of the specimen drawn. Statistical analysis Simple statistical analysis was done by using Microsoft excel sheet. Mean, range and percentage of each parameter were calculated. RESULTS We have done the study over three years, which includes sample size 30 cadavers (10 cadavers per year). 1. Length of splenic artery trunk, lobar artery, segmental artery and trabecular artery (Table: 1) Mean length of splenic artery was 7.45 cms and range 2-11 cms. Mean length of the lobar artery was 3.24 cms and range 1.2 – 8 cms. Mean length of segmental artery was 1.21 cms and range 0.4-3 cms. Mean length of trabecular artery was 0.59cms and range 0.3-2.5cms. 2. Branching pattern of splenic artery trunk, lobar artery, segmental artery and trabecular artery (Tables: 2 and 3) Splenic artery trunk was bifurcated in 24 (80%) specimens (i.e. shows 2 lobar arteries), trifurcated in 5 (16.66%) specimens (i.e. shows 3 lobar arteries), and quadrifurcated in 1 (3.3%) specimen (i.e. shows 4 lobar arteries). Lobar artery was bifurcated in 19 (63.33%) specimens, trifurcated in 10 (33.33%) and quadrifurcated in 1 (3.3%) of specimens. The segmental artery was bifurcated in 28 (93.33%) and trifurcated in 2 (6.66%) of specimens. These values are shown in table no. 3. Percentage occurrence of segmental arteries (Table: 4) In only 1(3.3%) specimen we found that only 2 segmental arteries were present. in 18 (60%) specimens we found 4 segmental arteries supplying the spleen. 6 (20%) specimens were showing 5 segmental arteries in total. In 4 (13.3%) specimens we found 6 segmental arteries and in only 1 (3.3%) specimen we found 7 segmental arteries. 4. Percentage occurrence of origin, course of splenic artery and polar branches of splenic artery (Table: 5) In All the specimens the splenic artery was arising from coeliac trunk. 19 (63.3 %) specimens shows supra-pan-creatic course and 11 (36.6 %) specimens shows retropancreatic course of splenic artery. 8 (26.6 %) specimens shows only superior polar artery, 11 (36.6 %) specimens shows only inferior polar artery, 5 (16.6 %) specimens shows both polar arteries and 6 (20 %) specimens has no polar artery. Special observations: 1. In one specimen two lobar arteries are directly entering in to the spleen and one lobar artery dividing into two segmental arteries which are directly entering into the spleen without dividing into trabecular arteries. 2. In another specimen one lobar artery directly entering into the spleen and two lobar arteries are dividing into two segmental arteries each which in turn divided into two trabecular arteries each and enters into the hilum of spleen DISCUSSION Embryologically, Ventral splanchnic arteries are originally paired vessels. After fusion of the dorsal aortae they merge as unpaired trunks that are supplied to the viscera with the advent of longitudinal anastomotic channels(dorsal channel persists as gastroepiploic, pancreatico duodenal and marginal arteries of large gut; ventral channel persists as right and left gastric arteries). Numerous ventral splanchnic branches joined together and persist as celiac trunk, superior mesenteric artery and inferior mesenteric artery4 . Morita hypothesised that celiac trunk is formed by union of 1st, 2nd and 3rd root along with longitudinal anastomotic artery. 1st root corresponds with left gastric artery, 2nd root with splenic artery and 3rd root with common hepatic artery5 . Splenic artery usually arises from the celiac trunk. But sometimes it even arises from abdominal aorta directly around 1.3% of cases6, 7, 8. And sometimes it arises along with hepatic and superior mesenteric artery as a common trunk9, 10. Shoumura et al have found in their study that splenic artery was arising in common with gastric artery as gastroleinal trunk in 4 cases out of 184 cases; they also found in one case, the splenic artery was arising in common with superior mesenteric trunk as spleenomesenteric trunk11. Pandey S K et al have found that the splenic artery was arising from the celiac trunk in 90.6%, abdominal aorta in 8.1% and either from common hepatic artery or superior mesenteric artery in 1.3%12. Sometimes it even arises from superior mesenteric artery (2%) and sometimes it arises in common with left gastric artery forming gastroleinal trunk (2%) 13. In our study the splenic artery was arising from the celiac trunk in all the cases. Splenic artery runs as multiple loops or coils, one of the most tortuous arteries in the body. It runs along the superior border of the pancreas in the posterior aspect of the border, behind the omental bursa, and passes between the two layers of the splenorenal ligament to reach the hilum1, 14, 15, 16, 17, 18, 19. The course can be named as supra pancreatic and retro pancreatic based on major part of splenic artery running above or behind the pancreas. Splenic artery has shown supra pancreatic course in 68% and retro pancreatic course in 32% of specimens study conducted by ashoka et al13. In our study splenic artery has shown supra pancreatic course in 63.3% (19 specimens) and retro pancreatic course in 36.3% (11 specimens) of specimens. Pandey S K et have found supra pancreatic course in 74.1%, intrapancreatic course in 4.6%, anteropancreatic course in 18.5%, and retropancreatic course in 2.8%12. Muzaffer Sindel et al have divided the course of the splenic artery in to four segments. Supra pancreatic segment is between the origin of splenic artery and pancreas, pancreatic segment is most tortuous part and extends along a groove located on the posterosuperior surface of pancreas, prepancreatic segment which crosses the upper border of the pancreas and finally prehilar segment lies between the pancreatic tail and the splenic hilum20. The splenic artery divides in to 2 main branches which are superior and inferior primary branches21. Some authors even mentioned the primary branches as upper and lower polar arteries. These branches travel in radial direction and dissection in parallel to the vessels make partial splenectomy possible22. some authors even named the primary branches in to superior and inferior segmental arteries and supplies its own segment of spleen and even mentions that the superior and inferior segments of spleen are separated by a avascular plane perpendicular to the long axis of the spleen15. Some authors even mentioned that the splenic artery divides in to 2-3 primary main branches1, 19. Daisy Sahni et al have named the primary main branches of splenic artery as lobar arteries23 Results of our study are slightly low compared to other studies but we have seen the Quadrifurcation of splenic artery showing the spleen can have up to 4 lobes. Further the lobar artery divides into 4-5 or several segmental arteries and each supply a segment of splenic tissue1, 21, 23. And even mentions there is little collateral circulation at the segmental level and and occlusion of one of these arteries usually is associated with infarction of the corresponding region of the spleen1, 19. Further ahead it is mentioned that these segmental arteries divide into trabecular arteries with no collateral circulation19. In our study we have observed the branching of splenic artery slight differently. The splenic artery was dividing mainly in to lobar arteries. Lobar arteries were in turn divided into segmental arteries and most importantly in most of the specimens the segmental artery was dividing into trabecular arteries outside the splenic parenchyma, at hilum before entering into the spleen. And there was little anastomosis between the segmental arteries but never between trabecular arteries. We have found the splenic artery dividing into 2-4 lobar arteries. We have seen the lobar artery bifurcation, trifurcation and even Quadrifurcation. And we have observed origin of 2-7 segmental arteries on an average (Table 2 and 4).the segmental arteries were bifurcating and trifurcating and giving around 2-8 trabecular arteries. It shows that spleen consists of 2-4 lobes and 2-7 segments supplied by a separate arterial segment. Some authors even mention differently that the splenic artery after reaching the splenic hilum divides in to 5-8 terminal branches and enters into the spleen, without mentioning the different levels of branching pattern of splenic artery14, 16, 17. Splenic artery branching pattern can be even classified in to two different types. Distributed type which is most common around 70%, distinguished by short trunk and too long branches entering in to the spleen and magistral/bundled type which is less common type, around 30%, where the splenic artery has got long trunk and short branches arises at hilum and enters the spleen18, 27, 28. Similar results were found in our study. Karl H Truetner et al has found distributed type around 84% and magistral type in rest24. Similarly ashoka et al have found distributed type in 54% and magistral type in 34% but have found the splenic artery entering without branching in 12%13. A vessel is considered polar artery if it is penetrating the upper/ lower pole of spleen without entering the hilum, it may be superior polar artery or inferior polar artery29. Katritsis E et al have found polar arteries arising from the trunk of splenic artery or from its primary branch25. Segments of the spleen are supplied by polar arteries known as polar segments30. Liana Ferreira et al has classified the polar arteries in to two varieties based on their artery of origin. Polar artery type I- collateral branch of the splenic artery originated prior to their terminal division being long and relatively wide, directed to one of these spleen extremities. Polar type II artery- secondary/ tertiary branch of terminal division of the splenic artery, being short and thinner, also directed to one pole of the spleen. They have found the occurrence of polar artery type I in 10%, polar artery type II in 28.3% and polar artery type I and type II together in 8.3% of specimens3 . So there is no uniform description of branching pattern of splenic artery is mentioned in the standard text books, that need to be updated for proper understanding of splenic artery anatomy as well spleen The length of the splenic artery from its origin to dividing into lobar arteries is 76.5mm in males and with a slight difference in females around 76.05mm23. Ashoka et al have found the length of splenic artery < 8cms- 10%, 8.1-9cms – 34%, 9.1-10cms – 44%, 10.1- 11cms – 06%, >11.1 cms- 06% of specimens13. Jauregui E et al have mentioned the average length of the splenic artery is 10.6cms32. In our study we have found the mean length of the splenic artery 7.45cms and range is 2-11cms. We have even measured the length of lobar arteries, segmental arteries and trabecular arteries (Table:1). Length of terminal branches/ trabecular artery mentioned by Liana Ferreira et al is Ave- 2.89cms, range 1.04-5.05cms3 and which is slightly higher the length we found in our study. Terminal branches are the branches from the segmental arteries which enter into the splenic tissue at hilum.   CONCLUSIONS The spleen is very important organ physiologically which is very important for the maintenance of human immunity function. Spleen has to be retained without removing it completely whenever there is possibility. The knowledge of origin, course, length and branching pattern of splenic artery is very important for interpreting colour Doppler and arteriography of upper abdomen and also for performing the splenic artery embolism which is done preoperatively to reduce vascularity of spleen. The splenic artery embolism is also done sometimes alternative to the surgery for preserving the spleen in nonoperative splenic injuries. The knowledge of segmental vascular anatomy of spleen including polar segments is very important for the limited resection/partial resection of the spleen. We being anatomists feel proud to provide the findings of our study on splenic artery anatomy, its different branching pattern, morphometry of the artery and its branches will be a supplement to the existing knowledge and it is very useful for the surgeons and radiologists. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Englishhttp://ijcrr.com/abstract.php?article_id=759http://ijcrr.com/article_html.php?did=7591. Susan Standring. Gray’s Anatomy, The Anatomical Basis of Clinical Practice.40th ed. Elsevier Churchill Livingstone Publications; 2008: 1116-1117, 1193 2. Petroinu A. O Baco. 1st edi Sao Paulo: CLR Balseiro; 2003 3. Liana Ferreira Alencar Silva, Lívia Mara Almeida Silveira, Paula Sátiro Timbo, Sanna Roque Pinheiro, Larissa Vasconcelos Barros, Antonio Ribeiro da Silva Filho,TCBC-CE.Morfometric study of arterial branching of spleen compared to radiological study. Rev. Col. Bras. Cir. 2011; 38(3): 181-185 4. Datta AK. Essentials of human embryology. 4th edi. Current books international; 2007: 185, 192-193 5. Morita M. Reports and Conception of 3 anomalous cases of the celiac andsuperior mesenteric arteries. Igaku Kenkyu. 1935; 9: 1993-2006 cited by AkiraImura, Takeshi Oguchi, Masakazu Shibata, Tsuneo Takahasi. An Anomalouscase of the hepatic artery arising from the superior mesenteric artery. OkajimasFolia Anat. Jpn. Aug 2007; 84(2): 64-66 6. Oh E, Gross BH, Williams DM. Independent origin of the hepatic and splenicarteries from abdominal aorta: CT demonstration. J Comput Assist Tomogr.1998 Jul-Aug; 22(4): 669-70. 7. Fligashi N, Hirai K. A case of three branches of celiac trunk arising directly from the abdominal aorta. Kaibogaku Zasshi. 1995 Aug; 70(4): 349-52. 8. Yamaki K, Tanaka N, Matsushima T, Miyazaki, Yoshizuka M. A rare case of absence of celiac trunk: the left gastric, the splenic, the common hepatic and the superior mesenteric arteries arising independently from abdominal aorta. Ann Anat. 1995; 177(1): 97-100. 9. Sridhar Varma K, Pamidi N, Vollala VR, Bolla SR. Hepatospleno-mesentric trunk: A case report. Rom J Morphol Embryol. 2010; 51(2):401-2 10. Losanoff JE, Millis JM, Harland RC, Testa G. Hepato-spleno-mesentric trunk. J Am Coll Surg. 2007 Mar;204(3):511 Epub 2006 Sep 26. 11. Chen H, Yano R, Emura S, Shoumura S. Anatomic variation of the celiac trunk with special reference to hepatic artery patterns. Ann Anat. Oct 2009; 191(4):399-407. 12. Pandey SK, Bhattacharya S, Mishra RN, Shukla VK. Anatomical variations of the splenic artery and its clinical implications. Clin Anat. 2004; 17: 497-502. 13. Ashok KR. Study of origin, course and branching pattern of splenic artery with its variations and clinical implications. Dissertation submitted to the rajiv Gandhi university of health sciences, Bangalore Karnataka. 2010; 41-57 14. G.J.Romanes. Cunningham’s text book of anatomy, 12th edi, Oxford medical publications; 924-925. 15. A.Lee Mc grego. Synopsis of surgical anatomy, 12th edi. Wright and Varghese company; 1999. 110-111 16. Keith.L.Moore, Aurthur F.Dally. clinically oriented anatomy, 5th edi. Lipponcott Williams and wilkins, a wolter kluver company; 284 17. T.S. Ranganathan. A text book of human anatomy. S chand and company limited; 2006: 282-83 18. Courtney M.Townsend, R.Daniel Beauchamp, B Mark Evers, Kenneth L.Mattox. Sabiston text book of surgery. The Biological Basis of Modern Surgical Practice, 19th edi, Vol II. Elseveir Saunders; 1548 19. Charles J. Yeo, Jeffrey B.Mathews, David W.Mc fadden, John H.Pemberton, Jeffrey H.Peters. Shackelford’s Surgery of the Alimentary tract, 7th edi, Vol II. Elsevier Saunders; 1611-12. 20. Muzaffer Sindel, Levent Sarikcioglu, Kagan Ceken, Saim Yilmaz. The importance of the anatomy of the splenic artery and its branches in splenic artery embolization. Folia Morphol. Vol. 60,(4); 2001: 333.336 21. Norman.S.Williams, Christopher J.K.Bulstrode , P Ronan O’ Connel. Bailey and love’s Short practice of surgery, international 26th edition. CRC Press-Publishers; 2013: 1087. 22. Josef E Fischer, Daniel B Jones, Frank B Pomposelli, Gilbert R Upchurch, V Suzanne Klimberg, Steven D Schwaitzberg, Kirby I Bland.Fischer’s Mastery of surgery, 6th edition,Volume II.Volter Kluver/Lipponcott Williams and Wilkins; 1853-55 23. Daisy Sahni A, Indarjit B, Gupta CN, Gupta FM, Harjeet E. Branches of the splenic artery and splenic arterial segments. Clin Anat. 2003; 16(5); 371-7. 24. Karl H. Treutner, Bernd Klosterhalfen, Gerd Winkeltau, Slyvia Moench, Volker Schumpelick. Vascular Anatomy of the Spleen: The Basis of Organ – Preserving surgery. Clin Anat. 1993; 6: 1-8. 25. Katritsis E, Parashos A, Papadopoulos N. Arterial segmentation of the human spleen by postmortem angiograms and corrosion casts. Angiology. 1982 Nov;33(11): 720-7 26. Sow ML, Dia A, Ouedraogo T. Anatomic basis for conservative surgery of the spleen. Surg Radiol Anat. 1991; 13(2): 81-7. 27. Charles Brunicardi F, Dana K. Anderson, Timothy R.Billiar, David L.Dunn, John G.Hunter, Jeffrey B.Mathews, Raphael E.Pollock. Schwartz’s Principles of Surgery. 9th ed. Mcgraw Hill Companies, Inc; 2010: 1247-49. 28. XU Wei-li, LI Suo-lin, WANG Yan, SHI Bao-jun, LI Meng, LI Ying-chao, ZHONG Zhi-yong and LI Zhen-dong. Laparoscopic splenectomy: color Doppler flow imaging for preoperative evaluation. Chinese Medical Journal.2009; 122(10): 1203-1208 29. Michels NA. The variational anatomy of the spleen and splenic artery. Am J Anat. 1942; 70: 21 30. JA Garcia Porrero, A Lemes. Arterial segmentation and subsegmentation in the human spleen. Acta Anat. 1988; 131: 276-283. 31. Mikhail Y Kamd, Nawar R, Rafla. Observation on the mode of termination and parenchymal distribution of splenic artery with evidence of splenic lobation and segmentation. J Anat. 1979; 128: 253-258. 32. Jauregui E. Anatomy of splenic artery. Rev Fac Cien Med Univ Nac Cordoba. 1999; 56(1): 21-41. 33. Shashikala Ramachandra londhe. Study of vascular pattern in human spleen. Dissertation submitted to Shivaji University Kolhapur. 2002: 19-22, 34, 35.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241618EnglishN2014September21COMPARISON OF MICROBIAL FLORA BY DEEP TISSUE BIOPSY AND SUPERFICIAL SWAB CULTURE OF SPECIMEN COLLECTED FROM VARIOUS ANATOMICAL SITES IN EARLY WOUND INFECTIONS English2428Saleem M.English Joseph Pushpa Innocent D.EnglishThe aim of this study is to evaluate and to compare the microorganisms isolated by two different methods of specimens collected from different anatomical sites in early wound infection, further to study the type of organisms grown in those sites. A total of 62 specimens were collected from 32 patients treated in Karpaga Vinayaga Institute of Medical sciences and Research Centre , during the period of six months from 15 .09 .13 to 15.03.14.Specimens were collected from gluteal, thigh, knee, leg, foot, breast, umbilical and genital regions. Initially a specimen was collected aseptically by common swab method from the wound and then the wound was cleaned, deep tissue biopsy was taken by scraping from the base of the same site of the wound to compare the two different methods of collection of specimens. Specimens were cultured by standard microbiological methods and the isolates were identified by standard biochemical methods. Among the 32 cases 7 were culture negative and the remaining 25 were culture positive. Most of the wound infections were presented in the foot 59.3% followed by leg 9.3 %. Knee, umbilical, gluteal and breast were presented with 6.2% of infection rate. Thigh and genital regions showed only 3.1% each. The commonest isolate was Staphylococcus aureus 41.2%. Out of the 14 isolates 12 were isolated from swab culture (35.3%). The next predominant organism isolated was E. coli which was 20.6 %, out of which 11.8% were isolated from deep tissue culture. Other isolates were Klebsiella 11.8%, Proteus and Pseudomonas spp were 8.8% each, Streptococcus 5.9% and Acinetobactor 2.9%. On comparison with the rate of isolation of organisms, it was more in swab culture (73.5%) than in the deep tissue culture (26.5%). Staphylococcus aureus found to be the most common Gram positive organism in the swab culture and E.coli was the more common Gram negative organism isolated in deep tissue culture. Out of 25 culture positive cases, 2 of them showed the same organisms both in swab culture and in deep tissue culture (8%). However the organisms isolated in swab culture were highly differ with deep tissue culture (28%). This study results reveal that the wound infections commonly seen in foot followed by leg. The common organism seen in swab culture is Staphylococcus aureus and the common Gram negative organism isolated was E.coli which is more predominate in deep tissue culture. EnglishWound infections, Deep tissue culture, Superficial swab cultureINTRODUCTION Skin as protect layer which prevent the underlying vulnerable tissues from the attack of various microorganisms. A major non specific protection as a physical barrier with salt and sebaceous secretions, does not allow the action of environmental microbial flora. Any damage or loss to the intact skin will prove the colonization, invasion and the pathogenesis of verity of microbial flora, best observed in burn wound infection. In spite of careful preventive measures, human got wounded in the modern mode of life either by cut wound, burn wound or by infections. However the wound or ulcer easily get complicated by patients won flora or by environment contamination. Open wound provide moisture and nutrition, microbes colonize easily and proliferate. Therefore it is important to identify the etiological agents and its antibiotic susceptibility pattern for proper treatment. Previous study reports revealed that opportunistic pathogens of patients won flora and the immune status of the patient plus the depth and the location of the lesion are the major contributive factors.(1) Chronic wounds are mainly caused by endogenous mechanisms (2).Acute wounds usually caused by external damage to intact skin such as bites, cuts or burn wounds. It was observed the microbial flora differ with acute wounds and the chronic ones. In acute wounds most frequently the normal skin flora of Gram positive cocci are common latter, the gram negative bacilli will be predominate and are involved with deeper tissues. Anaerobic organisms will occur in very later stage (3). Studies revealed that deep tissue biopsy is the gold standard in culture technique (4). Swab cultures are regarded as the least reliable (5-6), they often lack the true pathogens, however they cannot completely ignored.It is useful in acute wound infections. Therefore results from swab cultures also used in the identification of pathogens in wound infections (7-8). Thus a wide range of diverse claims were made by different researchers. This study is planned to compare the microbial flora in deep tissue culture and the superficial swab culture in early wound infection to study the efficacy of these methods. Further to study the type of organism isolated from the wound occur in different parts of human body. MATERIALS AND METHODS A total number of 62 samples were collected from gluteal region, thigh, knee, leg, foot, breast umbilical and genital area in which, 28 were from deep tissue biopsy and the remaining 34 samples included wound swabs, pus and aspirates. Initially pus samples/ aspirates/ wound swabs or the scrapings from the base of ulcer were collected. For superficial swab culture the wound was cleaned with sterile saline and a sterile swab was being rotated directly on to the base of the ulcer. Following that, the deep tissue biopsy was collected. For deep tissue biopsy, the wound was cleaned well using sterile curette and forceps by an experienced clinician and the tissue materials were collected and sent to laboratory for immediate processing .Both swab culture and deep tissue were collected from the same site for each patient. All the samples were collected aseptically from patients treated in Karpaga Vinayaga Institute of Medical Sciences. Informed consent was obtained from those who underwent the test procedure in this study. Ethics committee of Dr MGR University approved this study. METHOD Collected specimens were inoculated onto appropriate culture media (5% blood agar and macConkey agar) and incubated aerobically at 37 ° C for 24 to 48 hours. Organisms grown on culture media were identified by standard microbiological methods. Only qualitative bacteriology was performed. A direct Gram stained smear was examined from each sample. Presence of bacteria and pus cells were regarded. The Gram stain results were studied in comparison with isolation of organisms. As the study designed for acute and the early infectious period the exclusion criteria for the study were the gangrenous wound, patients with dry Escher and antibiotic use before hospitalization. As per the localization of the wound / ulcer /abscess they were classified in to three groups. Breast and umbilical region as group 1, gluteal, genital and thigh as group 2, Knee, leg and foot as group3. Wound formation occurred less than a month considered as acute infection. RESULTS Out of 32 patients included in this study 19 were males (59.4%) and 13 were females (40.6%).The age group ranges from 20 to70 years (Table 1). Wound infections were more common in foot 59.4% followed by leg (9.3%). Wound infection in the foot in males is 46.9% and12.5% in females. Age groups between 31-40 years and again 61 -70 years are prone for the wound infection on foot (Table 2). Among the 32 cases studied 7 were culture negative and the remaining 25 were culture positive (Table 3). Out of the 25 culture positive cases in superficial swab culture(SSC) all the 25 samples were showed growth in culture whereas, in deep tissue culture(DTC) only 16 samples were showed growth and the remaining 9 samples were culture negative (Table 4). Wound in the breast and umbilical region showed 6.2%. Wound infection on genital region and knee also showed 6.2% whereas thigh and gluteal region showed only 3.1% each (Table: 5).Commonest isolate was Staphylococcus aureus (41.2%). Out of the 14 Staphylococcus isolates 12 were isolated from swab culture (35.3%). The next predominant organism isolated was E. coli which was 20.6 %, out of which 11.8% were isolated from deep tissue culture. Other isolates were Klebsiella 11.8%, Proteus and Pseudomonas spp were 8.8% each Streptococcus 5.9% and Acinetobacter 2.9%. On comparison of organisms isolated, it was more in swab culture (73.5%) than in the deep tissue culture (26.5%) Staphylococcus aureus found to be the most common Gram positive organism in the swab culture and E.coli was more common Gram negative organism isolated in deep tissue culture (Table:6).Out of 25 culture positive cases 2 of them showed the same organisms both in swab culture and in deep tissue culture (8%). However the organisms isolated in swab culture were highly differ with deep tissue culture (28%). Direct Gram stain smear report showed Gram positive cocci in clusters, and in chains and Gram negative rods along with pus cells. It was observed that lot of pus cells were seen when there were more no of bacteria and less number of pus cells when no bacteria. In most of the culture positive cases the direct Gram stain report correlate with many pus cells and bacteria. DISCUSSION Usually open wounds are polymicrobial, however the superficial wounds and in the early infective phase are monomicrobial (9-10). The source of infection being the patients won flora of skin and mucous membranes, those organisms generally aerobic Gram positive cocci. If the wound occur near the genital and perineum the pathogens generally Gram negative bacilli like E.coli. Present study report showed that the foot infection is predominate (59.3%) and the most common isolate is Staphylococcus aureus 41.2% and most of the wounds showed monomicrobial growth. Our results correlates with Ana kaftandzieva et al.(2012)(11). In wound infection exogenous pathogens include Gram negative bacilli present in the nearby environment. In early acute wound, normal skin flora predominates. After about four weeks facultative aerobic Gram negative rods colonize the wound. E.coli, Proteus and Klebsiella are most commonly observed. Present study report showed 52.9% of Gram negative bacilli isolates from wound infections. The most common Gram negative isolate was E.coli (20.6%), among which 11.8% were isolated from deep tissue culture. The other isolates were Klebsiella 11.2% Proteus and Pseudomonas spp were 8.8% each. Similar findings were observed in studies done previously (12). Isolation of Staphylococcus aureus when compared to the isolation of any single Gram negative bacteria (except E.coli) the difference is statistically significant. (P=0.01). Different studies on wound infection with different conditions generate a verity of results, surface swab culture by the easy collection and reduce laboratory processing cost have attracted much attention as a potential alternate to the gold standard histology and quantitative culture method for microbiological wound monitoring. Gram stain examination was used for Gram stain affinity, morphology and arrangement of organisms however there were few reports suggested that direct Gram stain microscopy and the correlation of the culture report (13). In our study the organisms present in direct smear were generally isolated in culture too however, to prove this it requires further elaborate investigations. CONCLUSION In early wound infection the commonest pathogen isolated was Staphylococcus aureus, and the common Gram negative bacilli isolated was E. coli followed by Klebsiella. Swab culture is probably the most commonly used method to determine the resistant pattern of skin pathogens in clinical practice. Based on this study report surface swab culture may be considered as a tool for monitoring the surface wound with in the first few weeks of treatment. Patients who remain in the ward for a prolonged period deep tissue samples are justified for monitoring the bacteriological activity in wound infection. Superficial swab culture could be valuable to identify the pathogens in infected diabetic wounds without osteomyelitis, and deep tissue culture will be more sensitive and reliable in osteomyelitis cases. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors, editors and publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Englishhttp://ijcrr.com/abstract.php?article_id=760http://ijcrr.com/article_html.php?did=7601. Heinzeimann M, Scott M, lam T. factors predisposing to bacterial invasion and infection Am j Surg 2002 183 (2) 179-90. 2. Bowler PG,Duuerden PI,Armstrong DG Wound microbiology and associated approaches to wound management Cli Micobiol Rew 2001. 14; 244-269. 3. Anakaftandzieva, Zhaklina Cekovska, Igor Kaftandziev, Milenoa Petrovaka, Nikola Panovski Maced J Med Sci. 2012 http://dx.doi.org/10.3889/M/JMS 1857.5773 .2012. 4. Chamberlain N Wound management www.atsu.Edu/faculty/ Chamberline/ Website/Wound PPT 5. Mackowiak PA, Jones SR, Smith JW. Diagnostic value of scinus-tract cultures in chrnic osteomyelitis. J Am Med Assoc 1978; 239 2772-2775. 6. Sharp CS, Bessman AN, Wagner FM Jr,Garland D. Microbiology ofdeep tissue in diabetic gangrene.Diabetes Care 1978;1.289-292. 7. Sharp GS, Bessmanf AN,Wagner FW Jr,Garland D,Reece E. Microbiology of superficial and deep tissue in infected diabetic gangrene.Surg Gynecol Obstet. 1979;149: 217-219. 8. Sapico FL, Canawati HN, Witte JL, Montogomene JZ, Wagner FW Jr, Bessman AN. Quantitative aerobic and anaerobic bacteriology of infected diabetic feet.J Clin Microbil. 1980 12:413-420. 9. Kingsley A. A proactive approach to wound infection Nurs Stand. 2001;15(30).50-58. 10. Cutting KF, White R. Defind and refind criteria for identifying wound infection revisited British Journal of Community Nursing.2004.9 (3) 6-15 11. Ana Kaftandzieva, Zhaklina Cekovska, Igor Kaftazdziev,Milena Petrovska, Nikola Panvski. Bacteriololy of Wound- Clinical Utility of Stain Microscopy and the Correlation with Culture.Maced,J Med Sci 2012; as http:// dx.doi.org/10.3889/MJMS 1857-5773.2012.0201. 12. Uppal SK, Ram S, Kwatra B, Garg S,Gupta R. Comparativeevaluation of surface sawb and quantitative full thickness wound biopsy culture in burn patients. Burns 2007. 33 (4) 460. 13. Giacometti A, Cirioni O, Schimizzi M,Del Prete MS,Barchiesi F Derrico MM, Petrelli E, Scalise G. Epidemiology and microbiology of surgical wound infection. J Clin Microbiol 2000:95:1189-95.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241618EnglishN2014September21STUDY OF PSYCHIATRIC CO-MORBIDITY AND ASSOCIATED PSYCHOSOCIAL STRESS IN ATTEMPTED SUICIDE PATIENTS English2934R. TaraEnglish G. V. Ramana RaoEnglishIntroduction: The prevalence rates of suicides are on the raise in the developing countries particularly among farmers, students and the marginalized sections of the society. This imposes great psychological stress to the bereaved families and great economic loss to the nation. Objective: To study the demographic profile and other related details like psychiatric co morbidity, psychosocial stress preceding the event, of attempted suicides in a rural setting. Material and Methods: This cross sectional study was conducted at the General Hospital attached to GSL Medical College, Rajahmundry, Andhra Pradesh, India. The sample size was 60. Data collection was done by predesigned proforma and health parameters are assessed using the standard research tools like Mini International Neuropsychiatric Interview plus (MINI), The presumptive stressful life event scale etc. Results: In this study out of 60 cases of attempted suicides 44 (73.3%) subjects belong to the age group between 15-35 years, 36(60%) are of female gender, 31 (53%) were educated,32(55%) are unskilled workers, 16(26.7%) belong to lower middle class,48(80%) belong to nuclear family, 41(68%)of them consumed organophosphorous poison to kill themselves, 31(55%) of them suffered from psychiatric illness before the attempt,42(73%)had significant life events in the past one year. Conclusion: Majority of the subjects who attempted suicides are young in age, belong to lower socioeconomic status, unskilled workers, had psychiatric co morbidity, illiterates, of rural origin, and the most common mode of the attempt being consumption of organophosphorous poison. EnglishAttempted suicide patients, Psychiatric co-morbidity, and psychosocial stressINTRODUCTION Death due to suicide ranks among the first few causes of mortality at present. This causes serious psychiatric morbidity among family members of the diseased person. It is considered as an important human tragedy from the national economic perspective as well. In the last half a century, suicide rates have increased by about 60%.1 Nearly one million people commit suicide worldwide every year (i.e. One suicide every 40 seconds) compared to approximately 400000 suicides every year, a decade earlier. Suicide is among the ten leading causes of death for all ages in most of the countries (WHO)2 . The term ‘attempted suicide’ encompasses a wide variety of self destructive behaviors ranging from serious, life threatening acts to relatively minor gestures primarily aimed at attracting attention. This ambiguity about the criterion has led to dissatisfaction with the term, and a number of alternatives have been proposed including deliberate self poisoning and self injury,3 non-fatal deliberate self harm or deliberate self harm,4 parasuicide.5 Psychiatric co morbidities in suicide attempters have been the interest of many researchers. Literature has recorded association of psychiatric and personality disorders in such cases, both in the West and in India. Prevalence rates of psychiatric disorders in suicide attempters have ranged from 11.6%6 to 93%7 .Prevalence rates of co morbid psychiatric disorders in suicide attempters have ranged from 7%8 to 82%.9 Risk for suicidal behavior differs markedly among individuals; factors such as socio-demographic differences, personality traits, and psychiatric disorders all contribute to individual differences in risk. The question of whether various risk factors contribute independently to suicidal behavior or whether some risk factors are confounded with more basic individual differences has not been thoroughly investigated but is highly relevant from the standpoint of risk assessment and prevention. AIM 1. To study the demographic profile and other related details of attempted suicides in a rural setting. 2. To assess the presence of psychiatric co morbidity. 3. To assess the increasing psychosocial stress preceding the event, that could be contributive to the event. 4. To assess any associated physical symptoms preceding the event. MATERIAL and METHODS Type of study: The current study is a cross sectional descriptive, inferential and hospital based study. Source of data: Sample for the current study are patients who had attempted suicide and were referred to the Psychiatric services at the GSL Hospital during the period December, 2012 to July, 2013. Method of collection of data: Sampling method: From the above sources, all consecutive cases attending out-patient Department of Psychiatry, who fulfilled the inclusion criteria and did not get excluded, were selected for the current study. Ethical Considerations: The study was approved by the institutional ethics committee and written informed consent was taken from the parents or caregivers of the child. Tools used for assessment: 1. An Intake Pro forma to record socio-demographic features and details of suicide attempts. 2. Socio- Economic sale by O.P.Aggarwal 3. Physical symptoms scale by Kapur. 4. Family and Social Integration Schedule - Venkoba Rao (1989) 5. The presumptive stressful life event scale. (Singh, G, et al 1983). 6. Mini International Neuropsychiatric Interview plus, English Version 5.0.0. RESULTS All the statistics were performed by using SPSS 16.0 trial version and MS Excel 2007. The descriptive statics were presented in the form of mean ± standard deviation and percentages. Chi-square test is performed to find association between categorical study variables. P < 0.05 was considered as statistically significant. DISCUSSION This study has provided information about the relationship of attempted suicide to a number of factors such as age, sex, marital status, employment status, educational background, method and circumstances led to attempt, motivation, and psychiatric diagnosis and stress associated with suicide attempters. Sociodemographic features Age (Fig 1): Peak occurrence of suicides was in the age groups of 15-35 the youngest and oldest being 16 and 66 years respectively. This finding coincides with the observations made by Srivatsava et al(2004)6 and Haw et al(2009)10. Rao (1965)11 noted that majority of individuals were in age range between 15- 25 years in both sexes. Gender (Fig 2): Female preponderance of 60% in the sample is in conformation with other studies on attempted suicide observed by Srivatsava et al (2004) 6 and Oquendo (2007)12 Contrary to the above male preponderance was seen in the studies of Rao(1965)11. Religion(Fig 4): It is very difficult to make any observations from the religious prospective as 85% Indian population are Hindus, which coincides with studies observed by Kumar et al(1995)13 and Joseph Raj et al(2000)14 . Education (Fig 5): Majority of the suicide attempters in the present study had only primary education. This is contrary to the study observed by Chandrasekaran et al8. (Table-1) Different domiciliary background could be the reason for this observation.   Socioeconomic status (Fig 7): The observation made in the present study that maximum number of suicide attempters belong to low socioeconomic sta-tus, which is in accordance with the findings observed by Chandrasekaran et al (2003)8.(Table-2), Haw et al(2001)10.   Stressful life events (Fig 16): In the present study 73.3% of the subjects suffered from stressful events in past 1 year and only 26.7% suffered from stress in lifetime events, which coincides with studies from Srivatsava etal (2004) 6 , Chowdhary et al(2007)18. CONCLUSIONS  • Majority of the suicide attempters were young and below 35 years of age. Women (73%) outnumbered Men in the study. More number (53%) of the subjects had education below or up to 10th Standard, (Fig 5). Most of the suicide attempters were married (75%). (55%) constituted unskilled labour by occupation (Fig 6), and (26%) belong to low-middle socioeconomic status, (Fig 7). All of the suicide attempters were from rural background.80% of the subjects belongs to nuclear families, (Fig 8). • Oral agents were used for attempting suicide in all fifty one patients of our study sample. The most common method of self harm was consumption of organophosphorous compounds (41patients) followed by drug over dose (10 patients). Majority of the subjects made an impulsive suicide attempt which constitutes 70% of the sample which may be another cause for the use of pesticides commonly for attempting suicide in this region (Fig 10). Lack of restriction for procurement of these compounds and easy availability may be the reason for the preference to use these agents for attempting suicide. • Stressful life events seemed to play an important role for attempting suicide of which 73% experienced in first one year and 26% constituted life time events (Fig 16). • 55% of the suicide attempters suffered from a psychiatric disorder and major depressive episode (28%) and alcohol dependence (13%) were found to be most common diagnosed disorders (Fig 15). • Only 22% of the subjects had left suicide note (Fig 11).This may be indirectly attributed to low literacy and rural domicile for majority of the patients. • 80% of the subjects were guilty of their suicidal behaviour after survival from the suicidal attempt, (Fig 13). • 75% of the suicide attempts were performed in solitude. Solitude may be considered as one of the risk factors for suicidal behaviour, (Fig 14). ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Englishhttp://ijcrr.com/abstract.php?article_id=761http://ijcrr.com/article_html.php?did=7611. Upreti DK. When life becomes a burden. Deccan Herald 2007; Nov 11:9 (col. 1). 2. World Health Organization. Suicide report, 1993: Geneva: World HealthOrganization. 3. Kessel N. self-poisoning. BMJ 1965; 2:1265-70, 1336-40. 4. Morgan HG, burns-cox CJ, Pocock, H, Pottle S. Deliberate self-harm. Clinical and socio-economic characteristics of 368 patients. Br j psychiatr 1975, 127:645-78. 5. Kreitman N, Smith P, Tan ES. Attempted suicide in social networks. Br j prev Soc Med 1969; 23:116-23. 6. Srivastava MK, Sahoo RN, Ghotekar LH, Dutta S, Danabalan M, Dutta TK, Das AK: Risk factors associated with attempted suicide: A case control study Indian J psychiatry 2004,46(1)33-8 7. Latha KS, Bhat SM, D’ Souza P suicide attempters is a general hospital unit in India. Their socio-demographic and clinical profile emphasis on cross cultural aspects. Acta psychiatr scand 1996, 94:26-30. 8. Chandrasekaran R, Gnanaseelan J, sahai A, swaminathan RP, Perme B. psychiatric and personality disorders in survivors following their first suicide attempt. Indian J psychiatry 2003;45(2);45-8 9. Gregory R. Grief and loss among Eskimos attempting suicide in western Alaska. Am J psychiatry 1994; 151:1815-6. 10. Haw C, Hawton K, Houston K, Townsend E. psychiatric and personality disorders in deliberate self-harm patients. Br J psychiatry 2001; 178; 48-54. 11. Rao VA. Attempted suicide: an analysis of one hundred and fourteen medical admissions into the Erskine hospital, Madurai, Indian J psychiatry 1965,VII(4):253-64 12. Oquendo MA, Bongiovi-Garcia ME, Galfalvy H, Goldberg PH, Grunebaum MF, burke AK et al. sex differences in clinical predictors of suicidal acts after major depression: a prospective study. Am J Psychiatry 2007;164;134-41. 13. Kumar PNS, kuruvilla K, Dutta S, john G. Jayaseelan. Psychological aspects of attempted suicide: study from a medical intensive care unit. Indian J Psychological Medicine. 1995; 18(2):32-42 14. Joseph raj MA, kumaraiah V, Bhide AV, social and clinical factors related to deliberate self-harm. NIMHANS J. 2000; 18(1and 2):3-18. 15. Harriss L, Hawton K, Zahl D. value of measuring suicidal intent in the assessment of people attending hospital following self-poisoning or self-injury. Br J Psychiatry 2005; 186:60-6. 16. Ponnudurai R, jeyakar J, Saraswathy M. Attempted suicides in Madras. Indian J psychiatry 1986; 28(1):59-62. 17. Suominen K, Henriksson M, Suokas J, Isometsa E, Ostamo A, Lonnqvist J. Mental disorders and co-morbidity in attempted suicide. Acta psychiatr scand 1996;94: 234-40. 18. Chowdhary AN, Banerjee S, Brahma A, Biswas MK. Pesticide poisoning in nonfatal, deliberate self-harm: a public health issue. Indian j psychiatry 2007; 49(2):117-20.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241618EnglishN2014September21CORRELATION OF AGE AND MORPHOLOGICAL CHANGES AT STERNAL END OF FOURTH RIBS AT RAJKOT REGION English3538Sunil M. DoshiEnglish Viral N. ChauhanEnglish H. M. MangaEnglish Kunal PipaliaEnglish Viral AgheraEnglish Dipen DabhiEnglishObjectives: To study metamorphological changes at sternal end of fourth ribs according to age in males. To find any bilateral variation in morphological changes for different ages. Research methodology: The samples consist of sternal ends of fourth ribs on both sides taken from the cadavers brought for postmortem examination. Total 140 rib ends were taken from 70 male bodies having more than 17 years of age. After removing soft tissues, Ribs were classified according to different phases and mean age for each phase had been derived. Observations and conclusions: the morphological changes were age dependent without any significant bilateral variation. Observations were compared with the previous study. EnglishSternal end of rib, Morphological changes, AgeINTRODUCTION Age determination from unknown skeletonised bodies depends on many factors. One of them is, whether the received skeleton is of young age or belongs to older age. It has been shown that accurate methods are available to justify younger ages, but the same becomes a difficult task with increasing age. For years, Methods are available for age estimation based on morphological changes in various places which include cranial sutures, auricular surface and pubic symphysis. The studies reflect that progress of suture closure and changes at auricular surface have only a very general relationship with age1 ,2 . Moreover, it has been shown that age estimation for a skeleton should not be based on pubic morphology alone3,4 . The existing method for age estimation using sternal end of fourth rib was developed by M.Yasar Iscan et al. (1984)5 on white males and in white females6 . The ribs are classified according to the various stages of morphological changes at their medial ends at different ages. MATERIAL AND METHODS The present study was conducted at the department of Forensic medicine and toxicology, P.D.U. Medical College and hospital, Rajkot with 70 male cases having age above 17 years. The materials for the present study consisted of fourth ribs, bilaterally. Materials were obtained from the cadavers brought for the post-mortem examination after taking necessary consent. The information about the age of the deceased was verified by necessary documents. Fourth ribs from both sides were removed by cutting them by bone cutters a few centimeters away from costochondral junction. After removing muscular tissues, the ribs were soaked in plain water (without added salt) in a glass container with appropriate identity tag for 1 to 3 weeks depends on detachment of tissues. All adherent soft tissues and costal cartilage were then easily detached. The ribs were given phase numbers (0 to 8) based on morphological changes noted at the costochondral junction with special attention to the pit, its shape, its depth, status of the walls, rim surrounding it and the overall quality of the bone itself. The phases are defined as phase 0 to phase 8 as described below. Phase 0 - The sternal surface of rib end is nearly flat with ridges. The rim at sternal end is regular with rounded edges, and the rib end is smooth and solid. Phase 1 - A very shallow, amorphous indentation present at the articular surface. The rim is rounded and regular. The bone remains firm, smooth and solid. Phase 2 - The anterior and posterior walls of the pit are making a V - shape deepness. Some scallops begin to form at the rounded edge of the rim. The bone is firm and solid. Phase 3 - The V-shape of the pit is wider with some increased depth, the walls become a little bit thinner. The rounded edges show regular scalloping. The bone is still firm and solid. Phase 4 - The pit has a wide V- or more or less narrow U-shape. The walls become thinner, but the rim maintains its roundness. Some areas still show scalloping. The overall quality of the bone is good with some decrease in firmness as well as density. Phase 5 - There is no any change in pit depth, but the walls continue to become thin and sharp, making pit shape wider V- or U. No any scalloping pattern remains. The rim starts to become irregular. The bone looses density and firmness further. Phase 6 - pit shape continues to become wider V- or U-shape with a noticeable increase in depth. The quality of bone deteriorates further and becomes more porous. Some projections start appearing from the rim. The walls are fairly thin and brittle. Phase 7 - pit depth shows no change, then the previous phase. Pit shape shows irregular and wide U like structure. Irregular bony projections are seen protruding from superior and/or inferior edges of medial end of the rib. The walls are very thin, brittle and having sharp edges. Phase 8 - in the last phase, overall quality of the bone has badly deteriorated with fragile walls, irregular projections from superior and/or inferior edges of medial end of rib, extreme porosity and comparatively shallow pit with wide mouthed U shape. The rib itself is extremely thin, light in weight at medial end. OBSERVATIONS AND DISCUSSION The data derived from the study is classified according to different phases as described in materials and methods. Mean ages, Standard deviation and standard error are derived from different ages found for each phase. Table-1 and table-2 shows that the mean age increases as the phase increases up to phase 5. Maximum number of samples were founded with phase 3 on both sides. No any sample found belongs to phase 0 and phase 8. One way anova analysis for left fourth ribs was applied, which resulted in F-ratio 48.636 and p-value 0.000 and for the right fourth ribs F –ratio is 45.339 and p-value is 0.000. The paired T test is applied to find bilateral variations of metamorphological changes according to age. The correlation coefficient is more than 0.9 for phase analysis. A correlation coefficient of more than 0.8 is suggestive of strong correlation7 . So it is concluded that metamorphological changes according to age have no any significant bilateral variation. Observations of present study related to phase method are compared with studies done by Iscan and Loth8 . Table-3 shows a comparison of phase changes in males belonged to modified Iscan and Loth study8 with the present study. Both the studies show that mean age increased as the phase increased. Iscan and Loth study8 shows mean age was gradually increasing from phase 1 to phase 8 while present study shows mean age is increasing from phase 1 to phase 5 but not for phase 6 and phase 7. This can be explained by the presence of samples having age more than 65 but shows the morphological changes of earlier ages as evident from table 1 and 2 under heading of maximum age. No any sample was found for phase 0 and phase 8. Mean age was approximately 2, 5, 14, 19, 23, 9 years more for phase 1 to phase 6 respectively in the present study as compared to study done by Iscan and Loth8 , suggests that changes related with phase are delayed in the present study as compared to Iscan and Loth study8 . The data graphically represented in a figure-1. CONCLUSIONS Morphological changes at sternal end of fourth ribs are age dependant. No any significant variability found in relation to the side of the ribs. The chances of significant variations in phase with the actual age increase for the samples belong to 65 years and above age, the cause of which remains obscure. Morphological changes related with phase are delayed in the present study when they are compared with previous studies of Iscan and Loth8 .   Englishhttp://ijcrr.com/abstract.php?article_id=762http://ijcrr.com/article_html.php?did=7621. McKern TW, Stewart TD. Skeletal age changes in young American males. Natick MA: Quartermaster Research and Development Command, Technical Report EP-45. 2. Osborne D, Simmons T, Nawrocki S. “Reconsidering the Auricular Surface as an Indicator of Age at Death”.Journal of Forensic Sciences. 2004 Sept; 49(5) :1–7. 3. Brooks ST: Skeleton age at death. Reliability of cranial and public age indicators. American Journal of Physical Anthropology. 1955; 13: 557-597. 4. Todd TW. Age changes in the pubic bone. I. The male white pubis. American Journal of Physical Anthropology. 1920; 3: 285-339. 5. Iscan MY, Loth SR and Wright RK. Age estimation from the rib by phase analysis: white males. J Forensic Sci. 1984(a); 29: 1094-1104. 6. Iscan MY, Loth SR and Wright RK. Age estimation from the rib by phase analysis: white females. J Forensic Sci. 1985; 30: 853-863. 7. Correlation coefficient, Finding your way around. Statistics 2[Internet]2014 [cited 2014 jan 7] Available from: http://mathbits.com/MathBits/ TIsection/Statistics2/correlation.htm 8. Iscan MY, Loth SR and Wright RK. Metamorphosis at sternal rib end: A new method to estimate age at death in white males. American Journal of Physical Anthropology. 1984(b); 65: 147-156