Muzaffer Şeker

Brachial plexus variations in human fetuses.

OBJECTIVEWe examined the anatomic variations of the brachial plexus (BP) in human fetuses. METHODSThis study was performed with 200 BPs from spontaneously aborted fetuses without detectable malformations. The plexuses were dissected, and the normal position and/or morphological variations of the BP were determined and photographed. RESULTSThere were no variations in 93 plexuses, and 107 plexuses were observed to have different variations. Morphological variations were observed more frequently among female fetuses and right sides. The BPs were composed mostly of the C5, C6, C7, and C8 nerves and the T1 nerve (71.5%). A prefixed plexus was observed in 25.5% of cases, and a postfixed plexus was observed in 2.5% of cases. In one case (0.5%), the C4 and T2 nerves joined the formation. The inferior trunk was not formed in 9% of cases. The superior trunk was not formed in 1% of cases. In one plexus, the superior trunk was formed by the ventral rami of the C4 and C5 nerves. In one case, the inferior trunk was formed by the ventral rami of the T1 and T2 nerves. Division variations were observed most frequently. There were also variations in the terminal branches, such as the roots of the median nerve joining in the distal part of the arm (8.5%), the axillary nerve being separate from the posterior division of the superior trunk (2.5%), and a connection existing between the median and musculocutaneous nerves (1%). CONCLUSIONKnowledge of BP variations is important for surgeons who perform surgical procedures in the cervical and axillary regions.

Distal femur morphometry: a gender and bilateral comparative study using magnetic resonance imaging

Among the anthropometric factors to be considered, anatomic differences in the distal femur and intercondylar notch have been implicated as a cause of the different rates of anterior cruciate ligament (ACL) rupture between men and women; therefore, in this study our aim was to evaluate a number of morphometric measurements in the distal part of the femur. Two hundred knee MRI examinations were analyzed: 56 male right, 44 male left, 42 female right and 58 female left. Measurements of the intercondylar height (ICH), intercondylar width (ICW), medial condylar width (MCW), lateral condylar width (LCW) and epicondylar width (EW) were obtained. The notch shape index (NSI) was also calculated. Statistical analysis for comparisons was done by Student’s t-test. Correlations between the parameters studied were calculated by Pearson correlation coefficients. Significant bilateral differences were not found (p>0.05). In all measurements, males showed significantly greater values than females (p<0.001). No difference was seen in the NSI between males and females (p>0.05). Conversely a significant association was obtained between age and all parameters. We conclude that the results of this study may be useful for anatomic evaluation of the distal femur region prior to orthopaedic operations.

The origin of gonadal arteries in human fetuses: Anatomical variations

Testicular arterial anatomy has been well studied because of its importance in testicular physiology, as well as testicular and renal surgery. In contrast to classical anatomical descriptions, it may originate from the suprarenal or lumbar arteries or a high-positioned origin, course behind the inferior vena cava or be doubled or arise from an inferior polar renal artery. Different developmental patterns as variations in relation to origin, course and number of the renal and gonadal arteries have been reported and discussed. This study was performed on 90 spontaneously aborted fetuses obtained from two different hospitals in Konya. The study was carried out on the testicular or ovarian arteries of fetuses fixed by immersion in 10% formalin. In all, 180 gonadal arteries were studied and 16 of them were found to have variations in their origin (8.8%). The variations of the gonadal artery origins could be classified into four types. The gonadal artery variations were more commonly found in male than the female fetuses and on the right side rather than the left. In the present study, it is clear that these variations are important not only from the developmental point of view or research interest, but they also may explain some pathological conditions. Knowledge of these variations may help to avoid the clinical complications especially during radiological examinations and/or surgical approaches in this region.

Klippel-Feil syndrome associated with persistent trigeminal artery.

Study Design. In the present report, radiologic find-ings of the patient with the Klippel-Feil syndrome associated with persistent trigeminal artery are reviewed. In same case, there was also spina bifida occulta, cervical spondylosis, atlanto-occipital assimilation, bilateral cervical ribs, and lack of flow signal in the C4 segment of contralateral vertebral artery. The persistent trigeminal artery and Klippel-Feil syndrome can be seen together and with the other anomalies. It should be considered that they might be related with the insufficiency or dysfunction of the embryologic developmental process. Objectives. To draw attention to this rare presentation of Klippel-Feil syndrome associated with persistent trigeminal artery. Summary of Background Data. Klippel-Feil syndrome is a congenital spinal malformation characterized by the failure in segmentation of 2 or more cervical vertebrae. Although the anomaly is defined by its skeletal component, Klippel-Feil Syndrome may also be associated with developmental defects in many other organ systems including the inner ear, spinal cord, heart, and genitouri-nary tract. The primitive trigeminal, otic, hypoglossal, and proatlantal intersegmental arteries are persistent fetal anastomoses between the carotid and vertebrobasilar circulations. The authors report the association of a persistent trigeminal artery with the Klippel-Feil syndrome. Methods. Radiologic findings of a case of Klippel-Feil syndrome associated with persistent trigeminal artery are described. Results. There was vertebral fusion, spina bifida oc-culta, bilateral cervical ribs, atlanto-occipital assimilation, and cervical spondylosis. Magnetic resonance angiography showed the persistent trigeminal artery between the left internal carotid and basilar artery, but there was no sign of flow in the C4 segment of right vertebral artery. Conclusions. It should be kept in mind that a persistent trigeminal artery and Klippel-Feil syndrome can be seen together and with the other anomalies. Because of this reason, this type of case should prompt a search for the other related anomalies, and magnetic resonance angiography can be used as a noninvasive diagnostic technique in the persistent trigeminal artery determination.

The evaluation of morphometry of nasal bone and pyriform aperture using multidetector computed tomography.

Introduction The aim of this study was to measure nasal bone (NB) and pyriform aperture (PA), morphometrically. Besides, the different types of NB and PA were classified and determined the sexual differences. Materials and Methods Our study was performed on 120 (60 women, 60 men) multidetector computed tomography images obtained from patients who underwent radiologic examination in the Department of Radiology of Meram Faculty of Medicine, Necmettin Erbakan University. The right, left, and median heights of NB; the superior and inferior widths of NB; the width of PA; and the distance between rhinion and anterior nasal spine (as the height of PA) were measured. Frontonasal and internasal angles were also determined. All data were analyzed statistically using Student’s t-test. Results The other data of men were higher than of women except for the superior and inferior widths of NB and the frontonasal angle. We also determined the ratio of the height of PA to the height of NB on median plane and the ratio of the height of PA to the width of PA. They were found less than 2.0 in 64.2% and 100% of the cases, respectively. The NB and PA were classified into 8 and 7 different types, respectively. Conclusions The knowledge of the morphometric data and different types of the NB and PA is essential for sex determination, all surgical procedures related to this area, and nasal reconstructions.

The anatomic analysis of the vidian canal and the surrounding structures concerning vidian neurectomy using computed tomography scans

INTRODUCTION The type of endoscopic approach chosen for vidian neurectomy can be specified by evaluating the vidian canal and the surrounding sphenoid sinus structures. OBJECTIVE The variations and morphometry of the vidian canal were investigated, focusing on the functional correlations between them which are crucial anatomical landmarks for preoperative planning. METHODS This study was performed using paranasal multidetector computed tomography images that were obtained with a section thickening of 0.625mm of 250 adults. RESULTS The distributions of 500 vidian canal variants were categorized as follows; Type 1, within the sphenoid corpus (55.6%); Type 2, partially protruding into the sphenoid sinus (34.8%); Type 3, within the sphenoid sinus (9.6%). The pneumatization of the pterygoid process is mostly seen in vidian canal Type 2 (72.4%) and Type 3 (95.8%) (p<0.001). The mean distances from the vidian canal to the foramen rotundum and the palatovaginal canal were greater in the vidian canal Type 2 and 3 with the pterygoid process pneumatization (p<0.001). The prevalence of the intrasphenoid septum between the vidian canal and the vomerine crest and lateral attachment which ending on carotid prominence were much higher in vidian canal Type 3 than other types (p<0.001). The mean angle between the posterior end of the middle turbinate and the lateral margin of the anterior opening of the vidian canal was measured as 33.05±7.71°. CONCLUSIONS Preoperative radiologic analysis of the vidian canal and the surrounding structures will allow surgeons to choose an appropriate endoscopic approach to ensure predictable postoperative outcomes.

A Different Approach to Anatomy Education: “Sami ZAN, Professor of Anatomy, MD”

Sami ZAN was born in 1921 in Istanbul. After graduating from Istanbul Haydarpasa High School in 1940, he enrolled, upon the recommendation of the Ministry of Health and Social Aid, in the Istanbul Faculty of Medicine, Istanbul University. When he had completed his fifth year of education in this Faculty, again by instruction of the Ministry, he was transferred to the then newly-founded Faculty of Medicine at Ankara University. In 1946, he graduated from this Faculty, and after two years, in 1948, he started his first academic career as a research assistant in the Institute of Anatomy, affiliated with the Istanbul Faculty of Medicine, where he became an associate professor in 1955 and a full professor in 1966. He was appointed Chair of the Department of Anatomy of the same Faculty in 1978, and in 1982, he became the Head of the Departments of Morphology and Anatomy. He continued his successful services in this position until his death on the 24th February, 1984 (1). Sami ZAN was one of the prominent professors of Istanbul Faculty of Medicine, who gained legendary fame among physicians and scientists, not only because of his life-long services for and dedication to the Faculty, but also due to his extraordinary method of teaching as an anatomy professor (2). The features that make an academician a successful lecturer can be enumerated as follows: proficiency and competency in the field, team-spirited, sharing his/her knowledge generously with other academics, research fellows, assistants, and especially with students, motivating students and assistants to excel in the field and even become better than him/her, turning no one down from his/her circle, always keeping in mind that the most valuable wealth is to care for people and earn their respect, behaving towards them humbly and not being swayed by the ambition of making more money and without ever forgetting his/her teaching responsibility. After all, the title of teacher is not given by the one who is taught to the one who teaches, but is a type of eminent rank conferred by a third party (3). The reason for Sami ZAN having become a master-lecturer and a sage of Anatomy was because he possessed almost all of the above-cited desirable features and excellent merits in himself. Sami ZAN was an outstanding academician and lecturer during the times when there were none of the technological facilities that are available to us today and he even lacked, apart from cadavers, many of the resources and materials that are commonly used in anatomy education in the present day. Despite these drawbacks, he struggled to make everything that he taught in classes permanent, and moreover, he tried his best to make anatomy, against the contrary thinking of the time, more loveable for students, with the help of detailed drawings on the board and models constructed by any imaginable materials (such as paper, cartoons, lunch-boxes, hoses, cones, etc. (Figure 1) and sometimes even food (sandwiches, eggs, etc.) (1). FIG. 1. Prof. Zan gives a lecture by using the anatomical model made by himself (obtained from annual of Istanbul Faculty of Medicine) For example, during his teaching of ovulation, he brought to the class an already boiled egg and handed it over to one of his students. To demonstrate to his students that the misuse of a curette during abortion may result in uterus perforation due to the swollen and softened uterus, Professor ZAN brought along a large ripe pear, used a nail instead of a curette, pushed the nail from the bottom to the top of the pear and perforated “the uterus” (1). These examples could be multiplied. What is expected of a good lecturer, like Sami ZAN, is that the lecturer handles extremely complex topics with ease, manages to present them in an intelligible manner with clinical pictures and implementations displayed on a cadaver and actively involves the students in the teaching process through interactions with one another, thus helping them to digest the subjects that are studied and taught in the class. It is through this effective method of teaching practiced by Sami ZAN that students will continue to appreciate all that has been transmitted to them in class and also remember them throughout their lives. Another factor which made the classes of Sami ZAN quite interesting was that he used to come to classes half an hour earlier and start discussing, under the title of philosophical anatomy which had become a common and open lesson followed, not necessarily by the students of the medical faculty, or even by the students of many other faculties such as law, pharmacy, economy, etc., some interesting issues related to the subject-matter of the day and conveying to his students, with his own sense of humor, general knowledge sometimes about anatomy and sometimes about clinical anatomy, knowledge which he had obtained from newspapers and magazines. He would also answer the questions posed to him by his students (1,2). Professor ZAN regarded his students as precious and taught them first how to become a human being, and not just a doctor. His primary aim, as we all closely observed from his overall attitude, was first and foremost to raise a good human being rather than a good doctor. Some of his personal words testify to this, as, for instance, he would say: “most of the people listen to the warnings, but the wise make the most of those”; “a doctor is an eternal learner”; “the one who seizes the opportunity, seizes the life”; “no one is deafer than the one who won’t listen”; “looking is not staring at my face, it is to understand me”; “incompetence is the fountain-cause of jealousy”; “don’t promise the thing you cannot do, promise is a debt” and “persistence in flaws is the most fatal flaw.” Both in theory and practice, the lecturer indeed gave a life lesson to his students (1). Although anatomy is still trying to be learnt via cadaver dissection in many medical schools, whether dissection is the major and irreplaceable method and also useful for learning human anatomy remains controversial amongst anatomists (4). Apart from the traditional materials like cadavers and plastic models, this is thanks to the rapid technological development and its impact on our lives; also, teaching anatomy is now more miscellaneous (5). The number and quality of materials that can be used in anatomy training is diverse at the present time. Many new materials like computer applications and videos that can be watched and/or downloaded via the internet, 3D digital images and cell phone applications have all become very effective in today’s teaching and learning. Since anatomy is not a subject that can be learned easily in a short period of time and is also likely to be forgotten if learned by memorizing, lecturers should definitely make use of the technology. However, on the other hand, one needs to question how efficient it will be for a candidate physician to learn anatomy subjects and grasp its nature, philosophy and intricacies simply with the help of digital materials, without inhaling the scent of a cadaver and touching a cadaver with hands. In fact, in order to ensure the permanence of anatomy knowledge throughout the years, along with the cadavers, plastic models or digital images, we need to learn and teach anatomy by using everyday objects, by living, by reproducing, by being involved and by making others involved, just as Professor ZAN did previously. In the hope of serving as a model for new generations of academicians and candidate-physicians, we happily salute Professor ZAN, duly acknowledge his significant contributions to the field of anatomy and pay this modest tribute to his memory, hailing at the same time the legacy of his scholarship that will forever remain a source of inspiration and an exemplary guide for those who wish to take their academic journey in the footsteps of this great master-lecturer. Needless to say, his memory, his wisdom, as well as his superb teaching philosophy will continue to be remembered, appreciated and implemented by many of the medical experts and scientists who aim, like him, to raise their students as good human beings, while training them to be good and humble doctors.