Mehmet Çimen

Diploe thickness and cranial dimensions in males and females in mid-Anatolian population: an MRI study.

BACKGROUND The objective of this study is the classification of the thickness of diploe and dimensions of cranium at different points of cranium in men and women according to age groups. MATERIAL AND METHOD In the radiology archive, measurements were made at different points in magnetic resonance (MR) images of 305 (188 females and 117 males) patients, the average ages of whom were 40.98±20.44 (age range: 4-90) and who had no disorder of the bones. To determine diploe thickness, midfrontal, back and front bregma, lambda, opisthocranion and euryon points were used in the measurement. As for the determination of cranial volume, distances between glabella-opisthocranion, basion-vertex, basion-opisthion, euryon-euryon, nasion-basion, nasion-bregma, bregma-lambda and lambda-opisthocranion were measured. The data were loaded to Statistical Package for the Social Sciences (SPSS) 16.0 program. T-test, Mann-Whitney U, Pearson correlation coefficient and Kruskal-Wallis variance analysis were used in the statistical assessment. Results with a p value smaller than 0.05 were accepted as significant. RESULTS There was a statistically significant positive correlation between age and diploe thickness in all measurement points. The diploe thickness was also increased with age (p<0.05). In all points, average diploe thickness was higher in age 61 and over than the other groups (p<0.001). At the same time, diploe thickness in parietal bones was lower than frontal and occipital bones in both sexes. According to craniometric results cranium in males was bigger (p<0.001). While the distance between glabella-opisthocranion increased in both sexes aged 61 and over, basion-vertex height decreased in women in the same group (p<0.05). Interestingly, there was no meaningful statistical difference among age groups in terms of maximum cranial width (p>0.05). Foramen magnum length decreased related to age in both men and women (p<0.001). CONCLUSION These results related to diploe thickness and cranium dimension may be leading in the determination of sex and age; surgical interventions to the cranium and bone graft choice may increase the reliability of the operation.

The Relationship between Total Calvarial Thickness and Diploe in the Elderly

El objetivo de este estudio fue clasificar el espesor del diploe, laminas externa e interna y el espesor craneal total en diferentes puntos del craneo en hombres y mujeres ancianos. Desde el archivo de radiologia se obtuvieron imagenes de RM craneales de 220 pacientes (110 mujeres y 110 varones), cuya edad media fue de 73,23±8,4 anos (rango: 61 a 90 anos), quienes no tenian ningun trastorno oseo. Se realizaron mediciones de espesor del diploe, laminas externa e interna, y el grosor de la boveda craneal. Se utilizaron ocho puntos de la boveda craneal en la medicion: mediano frontal, bregma anterior y posterior, lambda superior e inferior, opistocranion y euryon derecho e izquierdo. Los datos fueron analizados mediante el programa SPSS 16.0. Para la evaluacion estadistica se utilizaron en las pruebas T-test, Mann-Whitney U, coeficiente de correlacion de Pearson y Kruskal Wallis de analisis de varianza. Los resultados con un valor de p inferior a 0,05 se aceptaron como significativo. Solo hubo diferencias estadisticamente significativas en el espesor total del craneo entre hombres y mujeres en el punto euryon derecho. El promedio de espesor total de la boveda craneal en el punto euryon derecho fue mayor en mujeres (6,20±0,78 mm) que hombres (5,96±0,68 mm) (p=0,02). El promedio de espesor del diploe fue mayor en mujeres que hombres, excepto para el punto de bregma posterior (p<0,05). Hubo una correlacion lineal positiva entre el grosor diploe y edad, excepto para opistocranion, euryon derecho y 1 cm inferior a lambda. Estos resultados relacionados con el espesor del diploe y espesor craneal pueden ser relevantes para la determinacion de sexo y edad; intervenciones quirurgicas en el craneo y la eleccion de injertos oseos, y puede aumentar la exactitud de la operacion.

Determination of Lateral Ventricle and Brain Volume in Children with Stereological Method Using MRI

Aunque el desarrollo del cerebro es mas activo durante el periodo de la vida intrauterina, los procesos de mielinizacion y arborizacion afectan a la estructura del cerebro durante la infancia y la adolescencia. El desarrollo del cerebro es activo en los primeros anos de la vida, y sigue siendo asi durante unos 15 anos despues de la gestacion. Cambios volumetricos en el cerebro son afectados segun el sexo. La comprension de la variabilidad del volumen del cerebro humano durante el desarrollo es importante para la interpretacion de los estudios de neuroimagen en la infancia. Por lo tanto, el objetivo de este estudio fue determinar, a traves de resonancia nuclear magnetica, los efectos de las diferencias de sexo en el volumen cerebral (VC), en el volumen del ventriculo lateral (VL) y la relacion porcentual de los volumenes del cerebro y del ventriculo lateral (% VLVC) de 90 ninos sanos entre 6-17 anos de edad, en ambos sexos. Los ninos fueron divididos en tres grupos de edad: 6-9, 10-13 y 14-17. El VC y el VL se calcularon utilizando el principio de Cavalieri, ademas de la relacion porcentual RLBV. El VC del grupo 6-9 anos fue significativamente menor que el de los otros dos grupos (p 0,05). El promedio general del grupo VL de 6-9 anos fue mayor que los otros dos, sin diferencia significativa entre ambos sexos. El VC siguio aumentando hasta los 10-13 anos en ambos sexos. Mientras LV aumento hasta los 10-13 anos de edad en los ninos, se observo en las ninas una relacion negativa con cambios de BV.

Morphometric Measures of Talus Bone in Skeleton Remains Belonging to Anatolian Geography

Abstract Morphometric properties of a bone structure enable the researchers to calculate all measures of a bone using a piece of it. The present study aims to evaluate all bone measures from the remains of talus bone. In our study, 40 talus bones existing in Cumhuriyet University, Faculty of Medicine, Anatomy Department Laboratory and belonging to Anatolian Geography (20 right-20 left) were evaluated. 10 measures of talus bone were evaluated and the differences between right and left were determined. Talar width (Tw) and head-neck length (Hnl) measures of left taluses are significantly higher than the right taluses (P<0.05). While right Tw is mean 40.7mm, left Tw is mean 43.3mm. The present study in which morphometric measures of talus bone, one of the durable bones of human body, are evaluated shall contribute to anatomic literature, anthropologic studies and forensic science. INTRODUCTION The studies focusing on determination of human skeleton remains are continuing increasingly. These studies can be morphologic or morphometric. Age, gender, race and stature surveys on the bones set light to forensic science and anthropologic studies. Measures of head, pelvis and long bones are used to evaluate population, gender and age. However, it may also be required to use other bones in the researches using bone pieces instead of the entire bone. Surface burials and poor protection lead to losses which prevent researches on skeleton material. Differently from head, pelvis and long bones, talus is protected better and its measures change less (1). During the researches to be made on skeleton material after death, talus provides the convenient conditions for osteologic analysis (2). Talus is considered as one of the durable bones of a foot (3). Therefore, talus studies are performed by the researchers in the field of anatomy, forensic science and anthropology (4-7). MATERIAL AND METHOD The talus bones used in this study were provided from the bone collection in Cumhuriyet University, Faculty of Medicine, Anatomy Department Laboratory. In our study, 40 talus bones (20 right-20 left) belonging to Anatolia region and protected well were used. In order to use in our study, 10 mophologic measures which are frequently used in literature were determined; Talar length (Tl),talar width (Tw), talar height (Th), trochlear length (Trl), trochlear breadth (Trb), head-neck length (Hnl),head height (Hh), length of the posterior articular surface (Lpas), breadth of the posterior articular surface (Bpas) and talar sulcus width (Tsw)(Figure 1). head Sliding caliper with 0.1 mm accuracy was used for the measurements. Statistical analysis and right-left difference of the measures were determined. In statistical analysis, SPSS (version 14) was used. Figure1. Measurement points of talus bone RESULTS Morphologic measurements and right-left differences of talus bone were analyzed statistically. Except for Hh and Tsw measures, left talus measures are bigger than right talus measures. Among these measurements, only left Tw and Hnl measures are statistically significant when compared to right measurements (P<0.05). The differences in other measurements are statistically insignificant (Table 1). Table1. Morphometric measurement values of talus bone Parameter Side N Mean SD SEM Tl R 20 55.94 3.07 0.68 L 20 56.54 3.65 0.81 Tw* R 20 40.79 4.74 1.06 L 20 43.39 2.87 0.64 Hnl* R 20 20.81 2.40 0.53

Estimation of the femur length from its proximal measurements in Anatolian Caucasians by artificial neural networks

Femora are a well preserved section of the skeleton after death. Therefore, they are commonly used in the field of forensic sciences, physical anthropology and anatomy. In addition, femur morphometry is helpful in finding sex or side (left or right) differences. The femur also shows characteristics of certain populations. Femur length is important for calculation of individual stature. In this study, the artificial neural network method was used to estimate femur length. In total, 230 femora exemplar were used. The three input parameters of the method were the distance between trochanter major top point and trochanter minor bottom point, the diameter of caput femoris and the diameter of collum femoris. By using these parameters, the artificial neural network estimation on femur length was performed. The results show that the method is capable of performing this estimation. In addition, sex discrimination was performed and achieved with 82% accuracy. As well as the identification of sex or side differences, morphometry of the proximal femur is necessary and important for surgical procedures.

Evaluation of the Vertebral Artery by 3D Digital Subtraction Angiography

El objetivo fue determinar el origen, nivel de entrada y diametro del foramen transverso, en funcion del sexo y lado sobre 79 arterias vertebrales a traves de imagenes angiograficas 3D utilizando el metodo de formacion de imagenes DSA. Durante la evaluacion radiologica, se utilizaron imagenes axiales, coronales y sagitales de la arteria. Los datos se procesaron en el programa SPSS 14.0 con las pruebas U de Mann Whitney y de significancia para evaluar la diferencia entre los datos. Mientras que 76 de las arterias vertebrales (96,2%) se originaron de la arteria subclavia, 3 de ellas (3,8%) lo hicieron directamente desde el arco aortico. En 67 de 76 arterias vertebrales, se observo el origin en la arteria subclavia a traves de C6; 6 a traves de C7, 2 a traves de C5 y una a traves del foramen transverso en C4. El diametro medio de la arteria vertebral fue 3,88±0,71 mm en el lado derecho (3,99 mm en hombres y 3,66 mm en mujeres) y en el lado izquierdo fue 4,15±1,05 mm (4,23 mm en hombres y 4,06 mm en hombres).

Fenestration of the vertebral artery: case presentation

Fenestrations of vertebral arteries are considered to be rare abnormalities observed in angiographic and autopsy studies. They result from vascular abnormalities that occur during the embryological development of vertebral artery. Fenestrations of the vertebral artery are vascular structures having 2 different lumens and endothelium layers, sharing either the same or separate adventitia layers. As a result of the carotid Doppler ultrasonography performed on a 65-year-old woman applying to the Neurology Clinic of Cumhuriyet University Faculty of Medicine, Research and Practice Hospital with the complaints of vertigo and numbness in the head, a plaque leading to 60% stenosis in the right internal carotid artery, close to the place of initiation was seen. The patient, whose vertebral artery lumen structures and calibrations have found to be normal in the Doppler ultrasonography of vertebral artery, was scheduled for double-sided selective carotid and vertebral artery angiography. With the performed digital subtraction angiography imaging method, an atheroma plaque, extending to internal carotid artery proximal starting from sinus caroticus through the right internal carotid artery and leading to 50% stenosis, having the appearance of an ulcer, was observed. In the vertebral artery angiography of the case, while the right vertebral artery was found to be normal, fenestration in the upper cervical segment was observed in the left vertebral artery. This situation has been presented in this paper with radiological and embryological evaluation.

RECOMMENDATİONS OF 5TH-GRADE MEDİCAL FACULTY STUDENTS ABOUT CLİNİCAL ANATOMY COURSE

Vedat Sabancıoğulları, Kaan Çimen, Güldal Doğruyol, Yaşar Taştemur, İlhan Otağ, Muhittin Sönmez, Mehmet Çimen 1 Department of Anatomy, Cumhuriyet University Faculty of Medicine, Sivas, Turkey Corresponding author: Vedat Sabancıoğulları, Department of Anatomy, Cumhuriyet University Faculty of Medicine, Sivas, Turkey E-mail: vsabanci@yahoo.com.tr Received/Accepted: August 12, 2017 / October 04, 2017 Conflict of interest: There is not a conflict of interest.

Assessment of dimensions of pneumatization of the anterior clinoid process in middle Anatolian population by computed tomography

BACKGROUND The anterior clinoid process (ACP) is usually removed during surgical procedures of the cellar region. The ACP may be different length and width in people; it may be also pneumatic. Therefore, we aimed to determine dimensions and rates of pneumatisation of the ACP in the large study group with clinically importance. MATERIALS AND METHODS One thousand and thirty-one (592 female, 439 male) cranial computed tomography (CT) of the middle Anatolian population was used in this study. The length and basal width of the ACP were measured on the cranial CT. Also; incidence and degree of ACP pneumatisation were identified. RESULTS The width of the right and left ACPs in females were 10.80 ± 2.27 mm and 10.53 ± 2.07 mm, respectively. The width of the right and left ACPs in males were 11.08 ± 2.39 mm and 10.98 ± 2.35 mm, respectively. The length of the right and left ACPs in females were 8.32 ± 2.40 mm and 8.34 ± 2.35 mm, respectively. The length of the right and left ACPs in males were 8.87 ± 2.62 mm and 8.93 ± 2.64 mm, respectively. There was statistically significant difference between males and females in ACP dimensions, except for the width of the right ACP. Pneumatisation of the ACP was observed on the right side in 46 (9.3%) cases, on the left side in 53 (10.6%) cases, and bilaterally in 32 (6.5%) cases. Incidence of pneumatisation of the ACP was decreased in the age group of 1 month to 20 years. While the incidence of bilateral pneumatisation of the ACP was higher in individuals aged 21-40. CONCLUSIONS Radiologically recognising pneumatisation and anatomical variations of the ACP may be helpful in decreasing the incidence of surgical complications during anterior clinoidectomy.

Central region morphometry in a child brain; Age and gender differences

BACKGROUND Data on central region morphometry of a child brain is important not only in terms of providing us with information about central region anatomy of the brain but also in terms of the help of this information for the plans to be applied in neurosurgery. OBJECTIVE In the present study, central region morphometry of a child brain in mid-sagittal MR images was analyzed in age and gender groups. MATERIALS AND METHODS Different points determined previously, commissura posterior0 (PC) and the distances between cerebral cortex point (VCS) vertical to commissura anterior- commissura posterior line, sulcus centralis (CS), sulcus marginalis (MS), and the angle (α) between CS-PC-MS were determined and measured together with difference of gender in three different age groups (aged 6-9, 10-13, and 14-17). RESULTS Central region measures of the brains of boys aged 6-17 are higher than girls except for MS-PC distance. While VCS-PC, CS-PC, and MS-PC measures display a significant difference in the girls aged 14-17 when compared to the other age groups of 6-9 and 10-13 (P < 0.05), angle α is not significantly different in age and gender groups (P > 0.05). However, while VCS-PC, CS-PC and MS-PC distances show a significant increase in girls beginning from the age of 14, this increase is limited in boys. CONCLUSION Morphometric differences observed in different age groups in boys and girls shall contribute our evaluation of the alterations in brain development in both of genders and shall be useful in preparation of surgical operation plans to be applied to the central region.