Nadire Unver Dogan

Accessory spleens at autopsy

Accessory spleens (AS) may be formed during embryonic development when some of the cells from the developing spleen are deposited along the path from the midline, where the spleen forms, over to its final location on the left side of the abdomen. An accessory spleen is usually near the spleens hilum, but it may be embedded partly or wholly in the tail of the pancreas. The aim of this study was to investigate the incidence and distribution of AS during routine forensic autopsies. AS were investigated in 720 consecutive autopsy cases. Fifty‐four AS were found in 48 (6.7%) cases. AS were found in hilum of the main spleen in 28 cases, the great omentum in 13 cases, the pancreas in 5 cases, and the pelvis in 2 cases. There were two AS in two cases and three AS in another two cases. Awareness of the possible presence of AS is important because when splenectomy is performed for some conditions such as immune thrombocytopenic purpura, failure to remove the AS may result in the failure of the condition to resolve. Additionally, during medical imaging, AS may be confused for enlarged lymph nodes or neoplastic growths. In conclusion, autopsy series are useful for determining the incidences and the other features of AS in different populations, in addition to those studies using CT scans and those studies obtained during laparoscopic or open surgeries. Clin. Anat. 24:757–762, 2011.

The course and variations of the branches of the musculocutaneous nerve in human fetuses

The course and branches of the musculocutaneous nerve (MCN) were dissected in 140 human fetal arms. The MCN entered the superior, middle, and inferior part of coracobrachialis in 43%, 37%, and 17% of arms, respectively, and the remaining 3% did not pierce coracobrachialis. The motor branches to biceps were classified as follows: Type 1 (83.6%): a single branch that bifurcated to supply the two heads of biceps; Type 2 (14.3%): two separate branches each innervating one head of biceps; Type 3 (2.1%): a single branch that bifurcated to supply each head of biceps plus an additional branch that innervated the distal part of biceps. The motor branches to brachialis were classified as follows: Type 1 (93.6%): a single branch to brachialis; Type 2 (6.4%): a single branch that bifurcated into two branches both supplying brachialis. Communications between the MCN and the median nerve (MN) were observed in 10% of specimens, of which three types (A, B, C) could be identified depending on their origin and union. In the most frequently observed type (B, 50% of cases) the communicating branch arose from the proximal part of the MCN and joined the MN in the middle or distal part of arm. The data presented here will be of use to surgeons, especially pediatric surgeons who undertake surgical procedures in the axilla and arm. Clin. Anat. 22:337–345, 2009.

The motor branches of median and ulnar nerves that innervate superficial flexor muscles: a study in human fetuses

PurposeWe aimed to describe the distribution of the motor branches of the median and ulnar nerves that innervate the superficial flexor muscles in detail, as well as to determine any communication between these two nerves in a series of 100 human fetuses.MethodsThis study was performed on 200 upper limbs from 100 fetuses. However, the motor branches of the median nerve were determined on 50 upper limbs because of the developmental properties of medial epicondylar muscles.ResultsThe motor branch, which innervates the pronator teres, is classified into two types and four subtypes. The flexor carpi radialis branch arose as a single branch in 30% of the cases. The innervation of the flexor digitorum superficialis was also performed by a single muscular branch in 88% of the cases and by two branches in 12% of the cases. The ulnar nerve was classified into two types according to the number of muscular branches in the forearm. Martin–Gruber anastomosis was observed in 7.5% of the cases.ConclusionsThese results show differences from classical definitions regarding the muscular branching patterns of the median and ulnar nerves. We suggest revisiting the classical descriptions of innervation patterns of pronator teres, palmaris longus and flexor carpi radialis muscles, since the variations observed in their innervation patterns are more diverse than has been described.

Communications between the palmar digital branches of the median and ulnar nerves: A study in human fetuses and a review of the literature†

In this study, median nerves (MNs) and ulnar nerves (UNs) were dissected in 200 palmar sides of hands (left and right) of 100 (50 male, 50 female) spontaneously aborted fetuses with no detectable malformations. The fetuses, whose gestational ages ranged from 13 to 40 weeks, were dissected under an operating microscope. The MN divided first into a lateral ramus and a medial ramus and then formed a common digital nerve. The first common digital nerve trifurcated in all of the studied cases. The branching patterns were classified into two types (Type 1 and Type 2) based on the relationship with the flexor retinaculum (behind/distal of it). A communication branch between the UNs and MNs in the palmar surface of the hand was found in 59 hands (29.5%). The proper palmar digital nerves were numbered from p1 to p10, starting from the radial half of the thumb to the ulnar half of the little finger, and these nerves exhibited six types of variations. The present data obtained from human fetuses will aid in elucidating the developmental anatomy of the nervous system and provide hand surgeons with a more complete anatomical picture to help them to avoid iatrogenic injuries. Clin. Anat. 23:234–241, 2010.

The Levator Claviculae Muscle and Unilateral Third Head of the Sternocleidomastoid Muscle: Case Report

Durante una diseccion de rutina, se observo en un cadaver de sexo masculino de 70 anos de edad, la presencia de una tercera cabeza unilateral del musculo esternocleidomastoideo y de un musculo elevador clavicular accesorio. En el lado izquierdo del cuello, se observo que el musculo esternocleidomastoideo poseia una tercera cabeza, ademas de las cabezas esternal y clavicular . El musculo elevador de la clavicula, tenia su origen en el tuberculo posterior del proceso transverso de la tercera vertebra cervical y se insertaba en el margen posterior de la clavicula. El conocimiento de estas variaciones pueden ser importantes debido a su estrecha relacion con las estructuras neurovasculares del cuello durante las operaciones.

Unilateral Variations of Vessels and Nerves in the Neck

Durante una diseccion de rutina, fue obserada en el lado izquierdo del cuello de un cadaver de sexo masculino de 65 anos de edad variaciones anatomicas vasculares y nerviosas. Se observo que el tronco linguofacial se originaba de la arteria carotida externa y que la arteria faringea ascendente se origina en la arteria occipital. Se determino que los ramos laringofaringeos originadas desde el ganglio cervical superior, giraban en torno al origen de la arteria tiroidea superior. Como una variacion adicional, la vena jugular interna se encontro dividida. El asa cervical y el vientre inferior del musculo omohioideo pasaban a traves de las partes de la dividion de la vena. Creemos que este tipo de variaciones supone dificultades importantes durante procedimientos radiologicos y quirurgicos de la region del cuello, y por tanto, es importante que los cirujanos conozcan estas variaciones.

Anatomical Examination of the Foramens of the Middle Cranial Fossa

Tres foramenes pueden ser identificados en el ala mayor del esfenoides: El foramen redondo (FR), foramen oval (FO) y el foramen espinoso (FS). Puede ademas existir otro foramen llamado foramen oval accesorio o foramen de Vesalio (FV), que conecta la fosa craneal media a la fosa pterigoidea. Se describe como una abertura con paredes lisas por anterior y medial al foramen oval, que conduce a un canal oblicuo dirigido hacia la fosa pterigoidea. FV estuvo presente entre FO y FR en 14 (31,8%) de 44 craneos secos y 6 (33,3%), en 18 lados en la base de craneos de cadaveres (total 20 (32,3%) de 62). El diametro de los foramenes en los lados derecho e izquierdo se observo casi simetricos. Las distancias de FR desde la linea mediana en el lado izquierdo fue mayor que en el lado derecho. Ademas, la distancia entre FO y el vertice de la porcion petrosa y la distancia entre el FS y el vertice porcion petrosa fueron mayores en el lado izquierdo. En el lado derecho la distancia entre A y FR, asi como la distancia entre A y FS fueron mayores. Por otra parte, la distancia entre los FR y el vertice del porcion petrosa fue mayor en el lado derecho. Las variaciones anatomicas en el tamano de la apariencia y la distancia de FR, DE, FS y FV son de gran importancia quirurgica. Podemos inferir que la informacion proporcionada en este estudio puede ayudar al neurocirujano y anatomista para aumentar el conocimiento sobre la anatomia de la fosa craneal media.

A complex variation of the parietal and visceral branches of the abdominal aorta

SUMMARY: Variations in the branches of the abdominal aorta were determined during a routine abdominal region dissection ofa 70-year-old male cadaver. Left gastric artery arose as the first root from antero-lateral of aorta. Coeliacomesenteric trunk occurred as athick root. After 29.9mm, coeliacomesenteric trunk bifurcated as coeliac trunk and superior mesenteric artery. Coeliac trunk bifurcatedas splenic artery and common hepatic artery. These multiple variations which change the normal anatomic structure of the abdominalaorta have to be kept in mind by surgeons, radiologists and anatomists. KEY WORDS: Abdominal aorta; Coeliacomesenteric trunk; Anatomical variation. INTRODUCTION Aorta, the main artery of circulation, is divided intothree according to its course; ascending aorta, arch of aortaand descending aorta. Passing through aortic hiatus undersidethe face of Th 12, aorta lies as abdominal aorta which is 13cm long and ends underside of L 4. The branches of theabdominal aorta can be classified as single-double orvisceral-parietal. Double visceral branches are (middlesuprarenal artery, renal artery, testicular artery (ovarianartery), single visceral branches are (coeliac trunk, superiormesenteric artery, inferior mesenteric artery), double parietalbranches are (inferior phrenic artery, lumbar arteries), andsingle parietal branch is median sacral artery (Standring,2005).Knowledge of such case has important clinicalsignificance in an abdominal operation or invasive arterialprocedure, that is by procedure and liver transplantation,laparoscopic surgery, and radiological procedures in theupper abdomen.

Evaluation of the facet joints with magnetic resonance images in the patients with disc degeneration and spondylolisthesis

PurposeWe aimed to research in detail the morphology of the facet orientation (FO) and tropism (FT) in degenerative diseases.MethodThis study consisted of patients with disc degeneration (DD) and with lumbar spondylolisthesis (LS) as well as a control group without these two diseases. The group of patients with DD was separated by DD grades. Vertebral body and intervertebral discs’ (IVDs) morphometric values, facet joint osteoarthritis (OA) grading, FO and FT were examined in all the groups. All measurements were applied to MRIs of 353 patients.ResultThere was a significant difference in facet angle values between the groups at L4–L5 (FO: p = 0.001). There was a significant negative correlation between FO at L4–L5 and L4 vertebral body anterior posterior diameter and L5 mid-vertebral body height, in 353 patients (p = 0.003; p = 0.010). Facet joint OA grading scores were lower in the control group than in the disc degeneration patient (DDP) and LS groups (p < 0.05). Sagittal FO was seen with the increase of facet joint OA scores at L4–L5 in the control and DDP groups (control: p = 0.001; DDP: p = 0.40).ConclusionFacet joints can show different orientation values in LS and DDP groups at L4–L5. The presence of FT is a risk factor for an LS patient at L4–L5. Sagittal FO is seen with vertebral slip at L5–S1. FO is affected by the morphometric changes of the vertebral body at L4–L5. Discussions in this regard need to be resolved through further research.

İnsan Isırığı Sonucu Gelişen Parmak Amputasyonu

Bite is a type of wound created with animal or human teeth. Bite wounds created by humans are encountered in situations as fighting, rape, murder and child abuse. Bite marks are usually observed on arms, neck, breasts, body, cheeks and legs. The teeth may penetrate to skin on the areas where bone or cartilage tissue lies underneath skin, and tissue loss may occur. Auricles are most frequent regions that occur tissue loss with bites. Finger amputation occurring with human bite is extremely rare. The case presented in this paper is a 28 years old man. In his medical history, the 3rd finger of his left hand was bitten during a fight two months ago. One centimeter shortness at the end point of the distal phalanx of the left 3rd finger because of tissue loss was found in the examination. In his left hand radiograph, bone defect at the middle part of the distal phalanx of 3rd finger was determined. The case has been discussed by comparing similar cases rarely reported in the literature.