Background:Hippocampal volume data from India have recently been reported in younger adults. Data in older adults are unknown. The present paper describes hippocampal volume from India among older adults and compares the same with patients having Alzheimer's disease (AD) and mild cognitive impairment (MCI).Materials and Methods:A total of 32 cognitively normal subjects, 20 patients with AD, and 13 patients with MCI were enrolled. Patients were evaluated for the diagnosis of AD/MCI using the National Institute of Neurological and Communicative Disorders and Stroke and the Related Disorders Association criteria and the Clinical Dementia Rating (CDR) Scale (score = 0.5), respectively. Hippocampal volume was measured using magnetic resonance imaging (MRI) machine by manual segmentation (Megnatom Symphony 1.5T scanner) three-dimensional (3D) sequences.Results:Age and duration of illness in the MCI group were 70.6 ± 8.6 years and 1.9 ± 0.9 years, respectively. In the AD group, age and duration of illness were 72 ± 8.1 years and 3.1 ± 2.2 years, respectively. In cognitively normal subjects, the age range was 45-88 years (66.9 ± 10.32) years. Mean mini–mental status examination (MMSE) score of healthy subjects was 28.28 ± 1.33. In the MCI group, MMSE was 27.05 ± 1.79. In the AD group, MMSE was 13.32 ± 5.6. In the healthy group, the hippocampal volume was 2.73 ± 0.53 cm3 on the left side and 2.77 ± 0.6 cm3 on the right side. Likewise, in MCI, the volume on the left side was 2.35 ± 0.42 cm3 and the volume on the right side was 2.36 ± 0.38 cm3. Similarly, in the AD group, the volume on the right side was 1.64 ± 0.55 cm3 and on the left side it was 1.59 ± 0.55 cm3. Post hoc analysis using Tukey's honestly significant difference (HSD) showed, using analysis of variance (ANOVA) that there was a statistically significant difference between healthy and AD (P ≤ 0.01), and between healthy and MCI (P ≤ 0.01) subjects. There was a correlation between MMSE score and hippocampal volume in the AD group.Conclusion:The volume of the hippocampus in older Indian adults was 2.77 ± 0. 6 cm3 on the right side and 2.73 ± 0.52 cm3 on the left side. There was a significant hippocampal volume loss in MCI/AD compared to cognitively normal subjects.
Objectives: Changes in serum cortisol levels have been reported in Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI). Atrophy of Medial Temporal Lobes (MTLs) is common in both conditions. Glucocorticoids are known to be neurotoxic and have been believed to cause damage to memory mechanisms in the brains; whether the same is applicable to AD/MCI is not known. Also, they have long been hypothesized to cause atrophy of MTLs but the proof of the same is lacking. The present study was performed to delineate correlations between serum Cortisol levels, Depression in Dementia and Medial Temporal Lobe Atrophy in patients with AD/MCI. Methods: We randomly recruited 28 patients out of a total of 65 presenting with subjective memory complaints to the Department of Neurology, at a tertiary care institute during the study period (July 2014-2015). Morning serum Cortisol levels (8 AM) were analyzed in all patients (n=28) who met the diagnostic criteria for diagnosis of probable AD e.g. National Institute of Neurological and Communicative Disorders and Stroke, Alzheimer's disease related Disease Association criteria (NINCDS-ARDA) and Clinical Dementia Rating (CDR) for AD and MCI respectively. The Cornell Scale for Depression in Dementia (CSDD) was used to evaluate Depression. Visual Rating of Medial Temporal Lobe Atrophy (MTLA) was done using the Scheltens Visual Rating Scale. An association between the Depression and MTLA was evaluated using Pearson correlation coefficient. Results: A total of 28 Patients (M: F=24:4, AD=13, MCI=15) were recruited for the present study. The mean age was 73.39 ±7.6 years and mean duration of illness was 3.4±3 years. Mean Mini Mental State Examination (MMSE) score was 21.7±7.4. A total of 4 patients (14%) had a high basal serum cortisol. Only one case out of these 4 had MCI and the rest had AD. There was a statistically significant correlation between serum Cortisol levels and MTLA (Pearson Correlation Coefficient=0.39, p<0.05). Similarly, a statistically significant correlation was found between serum Cortisol levels and CSDD scores (Pearson Correlation Coefficient=0.49, p<0.05). Likewise, there was a statistically significant negative correlation between MMSE and CSDD (Pearson Correlation Coefficient=-0.48, p<0.001). Conclusion : Statistically significant correlation between Serum Cortisol and MTA Scores as assessed by Scheltens Visual Rating Scores was found (Pearson Correlation Coefficient=0.39, p<0.05; 95% confidence interval=0.02 to 0.66). Similarly, a significantly correlation was present between serum cortisol and CSDD Scores (Pearson Correlation Coefficient=0.49, p<0.05; 95% confidence interval=0.144 to 0.729). This suggests that glucorticoids and depression and MTA in AD/MCI are interrelated and points towards the possible role that increase in endogenous glucocorticoids may play in pathophysiology of AD/MCI.
The commonest malignant ovarian tumour in the adolescent group is yolk sac tumour. It is commonly encountered in adolescents and young women. Incidence is 1% of all ovarian tumours. We reported a case of yolk sac tumour in a 9-year-old girl who presented with intermittent lower abdominal pain, not settling with medical management. Abdominal ultrasonogram showed a left adnexal echogenic mass measuring 5×6 cm with cystic spaces and internal vascularity. MRI abdomen showed T2/STIR hetero intense mass indenting the uterus and posterior bladder wall, multiple bilateral internal iliac, external iliac, left common iliac, aortic and bilateral inguinal nodes along with minimal ascites were seen. She underwent laparoscopy with trucut biopsy which showed moderate nuclear atypia with occasional Schiller-Duval body. Medical oncologist opinion was obtained and she was advised 4 cycles of chemotherapy with carboplatin, bleomycin and etoposide. Later she was planned for laparoscopic cytoreductive surgery. Laparoscopy showed rudimentary uterus, residual left ovarian mass, bilateral normal tubes and small pre-pubertal right ovary. Hence, left salpingo-oophorectomy, infra colic omentectomy and suspicious residual deposits of 1×1 cm near the right broad ligament were removed. Histopathological report of ovary showed no evidence of any residual malignancy. Peritoneum and omentum were free of tumour. Following laparoscopic cytoreductive surgery she is on follow up with AFP till date which is in declining levels and almost reached a normal value.
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