Mustafa Aktekin

OPIOID NEUROTOXICITY: COMPARISON OF MORPHINE AND TRAMADOL IN AN EXPERIMENTAL RAT MODEL

Histopathologic changes in rat brain due to chronic use of morphine and/or tramadol in progressively increased doses were investigated in this study. Thirty male Wistar rats (180-220 g) were included and divided into three groups. Normal saline (1 ml/kg) was given intraperitoneally as placebo in the control group (n = 10). Morphine group (n = 10) received morphine intraperitoneally at a dose of 4 mg/kg/day for the first 10 days, 8 mg/kg/day between 11-20 days, and 12 mg/kg/day between 21-30 days. The tramadol group (n = 10) received the drug intraperitoneally at doses of 20, 40, and 80 mg/kg/day in the first, second, and the third 10 days of the study, respectively. All rats were decapitated on the 30th day and the brain was removed intact for histology. The presence and the number of red neurons, which are a histologic marker of apoptosis, were investigated in the parietal, frontal, temporal, occipital, entorhinal, pyriform, and hippocampal CA1, CA2, CA3 regions. Red neurons were found in morphine and tramadol groups but not in the control group. The total number of red neurons was not different in morphine and tramadol groups, but the numbers of red neurons were significantly higher in the temporal and occipital regions in tramadol group as compared with the morphine group (p < .05). In conclusion, chronic use of morphine and/or tramadol in increasing doses is found to cause red neuron degeneration in the rat brain, which probably contributes to cerebral dysfunction. These findings should be taken into consideration when chrome use of opioids is indicated.

Genetic syndrome with ichthyosis: congenital ichthyosis, follicular atrophoderma, hypotrichosis, and woolly hair; second report

SIR, The ichthyoses are a heterogeneous group of skin disorders of epidermal differentiation, with both inherited and acquired forms. This cornification disorder may be found isolated or in association with other genetic defects. In 1998, five siblings with congenital ichthyosis, follicular atrophoderma, hypotrichosis and hypohidrosis were described as a new genodermatosis by Lestringant et al. We report a 17-year-old Turkish patient with ichthyosis vulgaris, follicular atrophoderma, woolly hair and hypotrichosis as a second report on this syndrome. A 17-year-old-girl was admitted to our hospital because of woolly hair, sparse eyelashes and eyebrows, and a very dry skin. She was born at term after an uncomplicated pregnancy. Ichthyosis and baldness were present at birth, but there was no history of a collodion baby. She had almost no scalp hair until she was 4 months old. In the early childhood period, funnel-shaped round follicular depressions had appeared on the dorsal aspects of the hands. She stated that her scalp hair had improved and straightened with age. The patient was otherwise healthy and detailed ophthalmological, neurological and audiometric examinations were normal. There was no history of atopy. There was no family history of similar skin problems. Both her parents and paternal grandparents were first cousins. There was no maternal history of drug intake during pregnancy. On examination, there was diffuse ichthyosiform scaling sparing the major flexures and face as in ichthyosis vulgaris (Fig. 1). The ichthyotic skin was hypohydrotic but the axilla, palms and soles sweated normally. Follicular atrophoderma was observed on the backs of her hands (Fig. 2). She had diffuse and patchy non-scarring hypotrichosis with a receding frontal hairline. Her hair was normal in length, but was light brown in colour, coarse, curly and unruly, in contrast to the straight black hair of the rest of her family. Eyelashes and particularly eyebrows were sparse (Figs 3–4). Routine haematological, biochemical, immunological, thyroid and radiological investigations were normal. Osteopoikilosis was not present on the X-rays. Echocardiography and ECG were normal. Hair microscopy was normal apart from curling. Biopsy from ichthyotic skin showed orthokeratosis with focal hypogranulosis (Fig. 5). Electron microcopy showed normal tonofilaments. Based on clinical and laboratory findings a diagnosis of ichthyosis vulgaris associated with follicular atrophoderma, hypotrichosis and woolly hair was made. The patient was prescribed 10% urea cream and salicylic acid ointments. The ichthyotic lesions resolved within a few weeks. Ichthyosis is a feature of several genetic disorders. These are rare disorders and the associated ichthyosis may be mild. The following syndromes with ichthyosis may be considered

Arteries of the thumb originating from the superficial palmar arch: five cases

Five cases are described where the first web space of the hand received arteries only from the superficial palmar arch. None of these branches was large enough to deserve the name “princeps pollicis artery”. These variations must be taken into account during surgical dissections of the hand.

Examination of the Accessory Tendons of Extensor Hallucis Longus Muscle in Fetuses

There are various data about the incidence of accessory tendons (AT) of extensor hallucis longus (EHL) muscle; however, their function is unknown. This study aimed to determine the incidence and morphometric features of the AT of EHL muscle in fetuses in order to provide more information to discuss its possible function. Forty‐five fetuses (26 female and 19 male) were used in this study. Fetuses were grouped as Group A (16–21weeks), Group B (22–27 weeks), and Group C (28–34 weeks) according to their age. In 23 (51%) out of 45 fetuses, there were AT. These were bilateral in 15 fetuses (65%) and unilateral in eight fetuses (35%). Fifty‐two percent of the fetuses in group A, 43% in group B, and 67% in group C had AT. AT were observed in 14 female (54%) and 9 male (47%) fetuses. In all cases, the AT were always diverging to the medial side of the main EHL tendons and attached to the metatarsophalangeal joint capsule distal to the joint space. Significant correlations were observed in this study between EHL and AT widths as well as between EHL width and EHL‐AT distance on both sides. The present study is the first to provide morphometric data about the AT of EHL muscle in fetuses which will be of use in understanding their function, particularly in biomechanics of the great toe. Clin. Anat. 21:713–717, 2008.

Morphometric comparison of the human corpus callosum in deaf and hearing subjects: an MRI study.

Auditory cortices are interconnected to each other by fibers passing through the corpus callosum (CC). In totally deaf persons no auditory impulses are conveyed to the auditory cortices, hence the auditory pathways become nonfunctional. It was reported that there has been cross-modal plasticity between auditory, visual, and somatosensory cortices. In this study, our aim was to make a comparison in the CC morphometry in hearing subjects and in a selected group in which the auditory system was deprived before the age of 2. 18 deaf and 18 hearing male, handedness matched volunteers, ages varying between 28 and 56 years old were examined. Audiometrical tests were applied to both groups and then T1-weighted midsagittal MR images were obtained. Certain dimensions and areas were measured on these images. There were no statistically significant difference between deaf and hearing subjects, either when dimensions and areas were analyzed by multivariate analysis of variance or when areas were analyzed by univariate analysis of variance. Absence of any significant morphometric difference in the CC of deaf subjects could be thought as an evidence of reflection of functional cortical plasticity.

Bilateral congenital anophthalmos and agenesis of the optic pathways.

This report presents a rare example of a bilateral congenital anophthalmos and an agenesis of the optic pathways. The MR imaging studies revealed that the eyeballs, optic nerves, optic chiasm, optic tracts and optic radiation were absent. The chromosomal examination was normal. Mild mental retardation was also observed. Apart from the rarity of the anophthalmos and the total absence of the optic pathways, no etiologic reason for this pathology could be detected, which makes this case more significant.

Multiple variations of the deep artery of arm: double deep artery of arm and deep artery of arm with the superior ulnar collateral artery: A case report

Multiple variations of the deep artery of arm were observed during routine gross anatomic dissection of the right upper extremity of a 54-year-old male cadaver. In this case study, a double deep artery of arm and the deep artery of arm with the superior ulnar collateral artery were reported. The anatomic origin of the deep artery of arm is variable. In the literature, a double deep brachialis since its origin is reported in 0.7% and the deep brachial with the superior ulnar collateral artery in 22.3%. Such variations are considered to be occurring during embryologic development. These type of variations are important both in surgical and clinical situations.

Discovering the "anatomy" in students' mind through metaphors.

PurposeThis study aims to obtain clues about the beliefs of medical students on learning anatomy through metaphor analysis which has not been used in this field before.MethodsA questionnaire was given to 174 medical students. Students were asked to complete the statement with a metaphor and to provide an explanation for it. All metaphors were grouped under 8 categories.ResultsThe most frequently produced metaphors were collected in two categories, namely “being lost/unknown situation” and “hopeless struggle.” These were the positions in which students feel themselves desperate, confused and lost (25%) or they consider their efforts to learn anatomy as an activity that is waste of time, ineffectual, and hopeless (24%). Only three out of eight categories (26%) had positive connotation.ConclusionsMetaphors acquired here reflect distress in anatomy learning. These results would direct the educators to revise educational methods and instruments to provide more efficient anatomy education.

Evaluation of the origin and branching patterns of the iliolumbar artery and its implications on pelvic and vertebral surgery

Objectives: To evaluate the origin, distribution pattern, branches, and neighboring structures of the iliolumbar artery (ILA) concerning the anterolateral surgical approaches to the spine. Methods: This study was performed in the Anatomy Department of Medical School, Mersin University, Mersin, Turkey between 2014 and 2015. Pelvises of 11 male formalin-fixed human cadavers were dissected by anterior and posterior approaches under surgical microscope. The origins, distribution patterns, calibers, and distances to certain structures were measured. Results: The ILA was found as a single trunk on 17 sides arising either from the IIA (12 sides, 70.6%) or the PT (5 sides, 29.4%). The average caliber of those originated from the posterior trunk was significantly larger (p=0.010). The ILA started as a single trunk in 17 sides, while its lumbar and iliac branches separately originating from different arteries in 4 sides. The close relation of the posterior rami of both the lumbar and iliac branches with transverse process and spinal nerve were noted. Conclusion: Findings suggest that the ILA and its branches may have different and significant patterns, which may be crucial to consider during certain surgical procedures, such as far lateral disc herniation and posterior pelvic fixations.

The morphological features of the mediopatellar and lateral folds of the developing knee joint: a fetus cadaveric study

OBJECTIVES The aim of the study was to evaluate the morphological features of the mediopatellar and lateral folds in fetal knees in the absence of any exposure to certain stress factors such as exercise or trauma. METHODS The study was performed in the knee joints of 15 fetuses (6 males, 9 females) obtained as spontaneous abortion material at 20-34 weeks of gestation. The mediopatellar and lateral folds of the fetuses were classified into eight subgroups according to the following morphological features: A- Absence of folds; B- Short vertical band; C- Long vertical band; D- Narrow horizontal band; E- Broad horizontal band; F- Horizontal band accompanied by a vertical band; G- Horizontal band without a vertical band; H- Fenestrated band. RESULTS The synovial membrane, covering the infrapatellar fat pad and forming the alar folds, extended upwards and formed the medial and lateral horizontal folds that covered the inferior part of the posterior aspect of the patella. These horizontal folds were thicker in the lower parts (close to their insertions) and became thinner towards the free ends. The horizontal band of the mediopatellar fold was observed in all cases, with an accompanying vertical band in 76.7% of the cases. A horizontally located lateral fold was absent in both knees of one fetus. The frequency of a horizontally located lateral fold was 93.3% and a vertical fold was accompanying in only 28.6% of these cases. It is of note that the horizontal band of the mediopatellar fold observed in all specimens has never been defined in previous classifications. In 10% of the knees, the vertically located part of the mediopatellar fold presented as a large band extending upward and being squeezed between the articular surface of the patella and the medial condyle of the femur. The lateral fold was observed as a large band in 10% of the knees. Another observation was that the higher level the vertical band of the mediopatellar and lateral folds began, the wider the horizontal band was, occupying more place in the patellofemoral space. It was remarkable that the frequencies of the vertically located parts of the lateral and mediopatellar folds in fetuses were higher than those reported for the adults in the literature. CONCLUSION Our findings suggest that the resorption process of the mesenchymal tissue, particularly in the lateral part, continues until adulthood and causes age-dependent alterations in the formation of intra-articular folds. The synovial folds occupy more space between the patella and femur in the early stages of life than seen in adults. This may be a more frequent cause of unexplained knee pain in children than expected.