Brijendra Singh

Anatomical Variations of Upper Segmental Renal Artery and Clinical Significance.

INTRODUCTION Classically each kidney is supplied by a single renal artery. In its course renal artery divides into anterior and posterior division, both of these division further divide into segmental arteries that are apical, upper, middle, lower and posterior. Segmental arteries are representing an end artery and they form independent renal segments. In their course they are closely related with collecting system. So, a thorough in depth knowledge of the variations in segmental arteries is a basic requirement for surgeons. AIM To observe and investigate the anatomical variations in arterial pattern of upper segmental renal artery and its relations with collecting system of ducts in human kidneys. MATERIALS AND METHODS Fifty human kidneys of both sexes were observed and studied by corrosion cast method. Different colour coded cast material (butyl butyrate) like red for artery and black for collecting ducts were used. 20% solution of butyl butyrate in acetone was injected into renal artery and ureter of the kidneys. After polymerization (24 hours) these kidneys were kept immersed in a bath of concentrated KOH solution at 50(0)C for 24-48 hours for corrosion to obtain the endocasts. These endocasts were cleaned and washed under running tap water and photographed. RESULTS In present study upper segmental artery was found in 49 (98%) kidneys. It was absent in 1 (2%) kidney. We observed four types of variations in arterial pattern of upper segmental artery namely Upper Segmental Artery Type-1 (USAT1), Upper Segmental Artery Type-2 (USAT2), Upper Segmental Artery Type-3 (USAT3), Upper Segmental Artery Type-4 (USAT4) and they were found in 20 (40%), 14 (28%), 10 (20%), 5 (10%) kidneys respectively. We also observed two different variations in the anatomical relations between upper segmental artery and collecting system namely Upper Segmental Artery Group -1 (USAG1) and Upper Segmental Artery Group-2 (USAG2). USAG1 was found in 40 (80%) kidneys and USAG2 in 9 (18%) kidneys respectively. CONCLUSION Anatomical knowledge of these variations is very important and useful for the uro-surgeons for best outcome and minimal complications in and during nephrectomies, removal of calculi, surgery of renal tumors or other various intrarenal surgeries.

Role of epidermal growth factor receptor expression in recurrent cases of oral squamous cell carcinomas

Background: Oral squamous cell carcinoma (OSCC) is the most common head and neck cancers and locoregional recurrence in OSCC is related to lowest survival rate. The present study was undertaken to compare the clinicopathological findings and epidermal growth factor receptor (EGFR) expression in recurrent and non-recurrent cases of OSCC. Methodology: A total of 64 cases of OSCC were studied and immunohistochemistry was done, of which, 33 cases recurred at end of follow up. Categorical variables for each case included age, gender, site of primary lesion, neck metastasis, AJCC stage, locoregional recurrence, histological grade and pattern of invasion. Results: In quantitative analysis, 7 cases (21.2%) of recurrent OSCC and one case (3.2%) of non recurrent OSCC with EGFR extent score 4 was observed. In qualitative analysis, 5 cases (3.22%) of recurrent group and one case (0.64%) of non recurrent group with strong intensity was observed. Recurrent cases of OSCC showed higher score of EGFR expression [extent {p-value 0.001} and intensity {p-value 0.03}]. However, on clinicopathological correlation of EGFR expression, no significant correlation was observed. In TNM stage IV, out of 22 cases only 7 cases (4.48%) showed recurrence. Among 26 cases, 17 Cases (10.88%) of recurrent OSCC with H/P grade I showed recurrence. Recurrence was frequently observed in 15 cases (9.6%) with pattern of invasion (POI) type II. Conclusion: The EGFR expression in between recurrent and non-recurrent OSCC can be exploited as prognostic /or predictive parameter despite its role as therapeutic marker.