Nadir Gülekon

Spinal intradural hydatid cyst in a child

Hydatid disease is an infestation by the larval stages of Echinococcus granulosus. In man, the liver and lungs are the organs most frequently involved. In the spinal column, hydatid disease usually begins in the vertebral body. Extension into the spinal canal results in spinal cord compression. Intradural hydatid cyst is extremely rare compared with the other types of spinal hydatid lesions (Rayport et al, 1964; Ley & Marti, 1970; Pamir et al, 1984). A 6-year-old boy was admitted to hospital because of progressive paraplegia, which had started 2 months previously. He was said to have lost bladder and bowel control in the last few weeks. Physical examination revealed marked reduction in the motor power of the lower limbs. There was bilateral clonus, a positive Babinskis sign and hyperactivity of the deep tendon reflexes at the lower extremities.

Observation of the relationship between the shape of skeletal muscles and their nerve distribution patterns: a transparent and microanatomic study.

Background: There are many gaps in the understanding of the neuroanatomy of skeletal muscles with regards to the nerve distribution pattern and shape of the muscles. This study was designed to examine the entire intramuscular nerve-distribution patterns of various human skeletal muscles. Methods: The relationships among nine skeletal muscles with various architecture (rhomboid major, biceps brachii, flexor pollicis longus, rectus femoris, sternohyoid, trapezius, masseter, digastric muscles) and their nerve-distribution patterns were investigated in four fetal cadavers using the Sihler staining method. The diameter and number of extramuscular (main) and major nerve branches, the number of minor nerve branches, and anastomoses were examined and evaluated statistically. Results: With regards to the number of extramuscular (main) nerve branches, the rhomboid major muscle resembled the flexor pollicis longus, trapezius, masseter, and sternohyoid muscles, and the anterior belly of the digastricus muscle (p > 0.05), whereas it was significantly different from the rectus femoris, the posterior belly of digastricus, and the long and short heads of the biceps brachii (p < 0.05). Trapezius and masseter muscles were different from all of the skeletal muscles that were studied with regards to the diameter of main branches (p < 0.05). The masseter muscle had the largest diameter (p < 0.05). With regards to the number of minor nerve branches, the sternohyoid muscle was significantly different from all the skeletal muscles that were studied (p < 0.05) except the short head of the biceps brachii, rectus femoris, and the posterior belly of digastricus (p > 0.05). As for the number of neural anastomoses, the sternohyoid muscle was statistically different from all skeletal muscles that were studied (p < 0.05) except the masseter and trapezius muscles (p > 0.005). Conclusions: A surgeons thorough knowledge of the relationship between the shape and nerve distribution pattern of skeletal muscles is important in successful reinnervation and regeneration of these muscles. It might also be useful in the field of muscle transplantation.

The incidence and types of sella and sphenopetrous bridges

The incidence and types of sella and sphenopetrous bridges were investigated in 37 adult male and 43 adult female (a total of 80) dry skulls with removed calvarias. In addition to this, the sellar and parasellar region of ten fixed cadavers (two female and eight male) were carefully dissected, and the individuals were examined for the evidence of sella and sphenopetrous bridges. Sella bridges were seen in 34.17% of the subjects overall. The trace, incomplete and complete types were 11.9%, 3.7% and 17.5%, respectively. On the other hand, sphenopetrous bridges were observed in 15.8% of the male and 4.9% of the female subjects overall. The cadaveric investigation revealed one trace, three incomplete, and one complete sella bridge in three cadavers. In addition to this, a complete sphenopetrous bridge was detected in one of the cadavers. Variations in the cranial base are of importance for surgical approaches in that location.

Demonstration of the Nerve Distribution of the Masticatory Muscles in Rabbits (Oryctolagus cuniculus)

Two methods can be used in order to demonstrate the nerve distribution of an organ. One is the three‐dimensional reconstruction of the innervation pattern of the organ by tracing images of that organ from serial histological sections. The other is the in toto staining of the organ with subsequent clearing of the muscles. In the present study, in order to visualize the nerve distribution of the organ, that organ was completely cleared and the nerve fibres were stained. Detailed morphological structure of the intramuscular nerve distribution of a certain region and its functions are of importance not only for anatomists and physiologists but also for clinicians. In this study eight New Zealand rabbits were used to visualize the intramuscular nerve distribution of the muscles involved in mastication (temporalis m., pterygoideus medialis m., digastricus m., retractor mandibulae m. and masseter m.). The main nerve bundle was observed entering into the muscle as a single trunk and dividing into three branches in the muscle. These branches were also observed dividing into several subbranches while going to the periphery. When the samples were examined under a stereomicroscope, ‘Y’‐, ‘I’‐ and ‘O’‐shaped communications between those branches were observed.

Intrathoracic lipomas demonstrated by computed tomography

Nine cases of intrathoracic lipoma are reported. Computed tomography (CT) proved to be helpful in the diagnosis and management of these cases. The attenuations of the masses ranged from -70 to -140 Hounsfield units (HU). In 4 cases, needle biopsies were taken, confirming lipoma with mature fat cells. One patient also had a coelomic cyst with an attenuation of 20 HU, which was confirmed at thoracotomy. Another had an atypical lipoma which infiltrated the thoracic wall but was benign. In conclusion, we recommended investigation with CT scan for the diagnosis of lipoma.

Phrenic Nerve Distribution in the Rabbit Diaphragm and Morphometric Analysis of Nerve Branches

The best method to evaluate the pathogenesis of diaphragmatic disorders is to demonstrate the distribution pattern of the phrenic nerve in the diaphragm. For this purpose the branching pattern and the microanatomic features of the phrenic nerve were observed in six rabbits. All diaphragms were stained by using Sihlers stain method. The phrenic nerve divided into three to four branches when entering the diaphragm. These branches were classified as sternal, anterolateral, posterolateral and crural. The crural branches were the thickest whereas the anterolateral branches were the thinnest. Knowledge about the distribution pattern of the phrenic nerve may be important in surgical approach to the diaphragm.

Age-related morphologic changes of the vertebral artery in the transverse process. Analysis by multidetector computed tomography angiography

BACKGROUND CONTEXT The V2 segment of the vertebral artery (VA) ascends and passes through the transverse foramen (TF) of the C6-C1 vertebrae. Atherosclerosis of the VA and degenerative changes in the cervical spine are likely to occur with aging, and subsequent morphologic changes may alter the normal anatomy. PURPOSE The aim was to determine the morphologic changes of TF and VA in relation to aging. STUDY DESIGN/SETTING This was a retrospective cross-sectional study. PATIENT SAMPLE One hundred ten consecutive patients who had undergone computed tomography angiography were included. METHODS The subjects were then divided into three groups according to age: Group A, less than 45 years; Group B, from 45 to 65 years; and Group C, older than 65 years. Cases with stenosis and dissection of the VA were excluded from the quantitative analysis. The areas of the VA and TF were measured, and the VA/TF occupation ratio (OR) was calculated accordingly. The presence of VAs tortuosity within the TF was also noted. RESULTS The TF was larger in the oldest group, but the difference was not statistically significant. There was also no significant statistical difference among the age groups in terms of the VA and VA/TF ORs (p>.05). In the Group C, the rate of overall tortuosity of the VA was 73%, and arterial tortuosity in the TF was 28.6%. In cases with tortuous VA, C6 and C4 TFs were found to be significantly larger. CONCLUSIONS Tortuous VAs tend to be associated with enlargement of C6 and C4 TFs. Knowledge of such changes in the anatomy is crucial during instrumentation used for cervical spine surgeries, to prevent serious complications in patients aged older than 65 years.

Clearing and embedding in polyester resin for demonstrating the nerve distribution pattern of skeletal muscles

The preservation of many stained gross specimens in solution creates some difficulties. It is convenient and effective to preserve material in polyester resin instead of glycerol. The aim of this study was to determine the usefulness of clearing and embedding using polyester resin. The samples consisted of the nerve distribution patterns of skeletal muscles stained using Sihlers method. The muscles were cleared more successfully and the intramuscular nerve distributions were demonstrated better in polyester than in glycerol. The method presented here eliminates not only the storage and handling problems of specimens, but also problems such as pale stains and the molding of preparations. Furthermore, it is more convenient to examine and to photograph specimens cleared and embedded in polyester than those stored in glycerol.

Congenital mesenteric aneurysm and mesenteric arterioportal fistula

A unique case with superior mesenteric artery aneurysm and arterioportal fistula resulting from mesenteric arteriovenous malformation is presented, and the relevant literature is reviewed.

Osseous bridging of lumbar transverse processes causing low back pain: A case report and review of the literature

Congenital or developmental osseous bridging between lumbar transverse processes is a very rare condition which may cause low back pain. Etiology of most of the cases is alleged to be post traumatic in origin whereas congenital nature is much less. The nature of bridging can not be determined just depending on patients medical history. Radiological findings such as shape and outlines of bridging help in differentiation of congenital and traumatic etiology. We present x-ray and multidedector CT (MDCT) findings of a girl as the youngest to be reported with congenital transverse process bridging in the literature.