Maulik A Vaja

Abstract

Introduction: The fracture of skull is considered as severe injury and have grave prognosis. It is mainly because of complications of the acute head injury affect the brain directly or indirectly. Compound depressed fractures are surgical emergencies and unless treated promptly and properly complications like meningitis, cerebral abscess and osteomyelitis of skull may occur. Objectives: to determine the causes of depressed fracture skull and its complications and also to find out various presentation and severity of depressed skull fracture and effective modality of management. Materials and Methods: A prospective study undertaken at department of surgery in coordination with emergency department. Detailed inquiry was done about history of demographic data, presenting symptoms and other diseases done. General, central nervous system examination, other systems examination and local examination were done thoroughly and documented. Patients were treated according conservatively and operatively as per decision taken by surgeon. Results: Out of total 100 patients, assault (43%) was most common, followed by vehicular accident (41%), fall of patients (15%) and fall of object on the patients (1%). Patients with severe head injury (GCS Conclusion: Conservative management is better in patients with CT scan suggestive of depressed skull fracture nor more than 10 mm and not intracranial hematoma. Patients with depressed skull fracture with more than 10 mm with severe head injury and associate hematoma are better managed operatively. Keywords: Depressed skull fracture, Operative management, Conservative management.

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Abstract

Introduction: Histomorphological grading of cervical malignancy is important for clinical management. Ki-67, a proliferation marker known as predictive factor for tumor development, is a nuclear antigen expressed during all active phases of the cell cycle. In normal cervical squamous mucosa, Ki-67 is detected essentially in parabasal epithelial layers. Ki-67 immunohistochemistry positivity demonstrates the increasing proliferation in low and high grades of intraepithelial lesions. Objectives: To analyse the expression of Ki-67 immunostains on nonneoplastic, dysplastic and neoplastic specimens and to study their role in increasing the diagnostic accuracy in equivocal cases on histopathology. Materials and Methods: It was a cross sectional study done over a period of seven months after Institutional Ethics Committee permission. Histopathological examination and clinical diagnosis of all included patients was done. Immuno-histochemical staining for Ki-67 was performed and evaluated light-microscopically. A tumor was considered positive with significant proliferating activity only if nuclear Ki-67 accumulation was identified in at least 10% of all malignant cells in a tissue section. Observations: Histopathological examination and clinical diagnosis shows cervical carcinoma was the commonest and was seen in 82.50% of patients. Followed by chronic cervicitis (7.5%), prolapse (5%) and Non-neoplastic cervical growth (5%). Ki-67 grading 50% (score 3) was seen in 40(50.0%) of cervical biopsies. Ki-67 immunostaining was negative in chronic cervicitis cases. Conclusion: Histological diagnosis of cervical biopsy samples, is observed to have significant inter-observer discrepancies. Therefore, there is a need for additional sensitive and specific biomarkers to improve cervical cancer screening which can improve standardization and quality control of histopathological diagnosis. Keywords: Neoplastic and non-neoplastic cervical lesions, Histopathological examination, Ki-67 grading.

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