Piraye Kervancioglu

Patterns of motor branching of the musculocutaneous nerve in human fetuses and clinical significance

The purpose of this morphologic study is to investigate the course and the branching pattern of motor branches of musculocutaneous nerve (MCN) in human fetuses. Twenty upper limbs (10 right, 10 left) of spontaneously aborted formalin‐fixed fetuses were dissected under a stereomicroscope to determine motor branches for the biceps brachii and brachialis and the communicating branches between the MCN and median nerve (MN). The MCN entered the proximal and middle part of coracobrachialis in 13/20 and 5/20 of arms, respectively, and the remaining 2/20 did not pierce coracobrachialis. The communication between MCN and MN was observed in 5/20 of the arms and detected only in the distal part of the coracobrachialis. The most frequently observed innervation is the type wherein a single branch to biceps brachii, which bifurcated for supplying the short and long heads (12/20). For the innervation of brachialis, the most frequent type was a single branch from the main trunk of the MCN (15/20). During the dissections, the distance between the acromion and the emerging point of the motor branches was measured. The mean distance between the acromion and the emerging point of the all motor branches for biceps brachii in all types of specimens was 33.8 ± 6.1% of acromion‐lateral epicondyle length and for brachialis was 50.6 ± 11.5% of acromion‐lateral epicondyle length. The data of the MCN variations in the human fetus may be useful for the clinicians and pediatric surgery. Clin. Anat. 24:168–178, 2011.

The effects of L-arginine on neurological function, histopathology, and expression of hypoxia-inducible factor-1 alpha following spinal cord ischemia in rats

The aim of this study was to investigate the effects of L-arginine (L-Arg) on neurological function, histopathology, and expression of hypoxia-inducible factor-1 alpha (HIF-1α) following spinal cord ischemia in rats, and the interaction between therapy with the nitric oxide donor L-Arg and up-regulation of the expression of HIF-1α. Thirty Wistar rats weighing between 200 and 250 g were divided into three groups, each containing 10 rats: group 1, sham operation; group 2, untreated ischemia-reperfusion (I-R); group 3, I-R plus L-Arg treatment. Spinal cord ischemia was applied for 20 min. There were no significant differences in mean arterial pressures, temperatures, and blood gas levels among the groups. In group 2, malondialdehyde values were significantly increased compared with groups 1 and 3. The rats with aortic occlusion in group 2 had paraplegia or paraparesis. In group 3, all animals were neurologically intact. In group 3, spinal motor neurons did not decrease significantly, and little proliferation of microglia was observed compared with those in group 2. In group 2, spinal motor neurons in ventral gray matter decreased significantly compared with those in groups 1 and 3. HIF-1α-positive immunostaining was mildly detected in group 2 animals. The expression of immunoreactive cells was intensely increased in spinal cord tissue from I-R/L-Arg rats. In conclusion, our findings suggest that HIF-1α-positive immunostaining may be critical factors in the pathophysiology of inflammatory spinal cord injury induced by I-R. Nitric oxide may play an important role in the immunohistochemical expression of these molecules, and the neuroprotective benefit of L-Arg may be attributed to preventing neural cell necrosis.

The Existence of Axillary Arch in Human Fetus and Applied Importance and Clinical Implications in the Axillary Brachial Plexus Blocks

El arco axilar es la variacion muscular mas comun de la fosa axilar, siendo de importancia para la region en los procedimientos de intervencion, los metodos de seleccion y el examen fisico. Con el fin de evitar las negligencias se debe tener en cuenta las variaciones. El objetivo de este estudio fue determinar la frecuencia y las caracteristicas del arco axilar en el feto humano. Es necesario mencionar la importancia del potencial clinico y funcional del arco axilar en la aplicacion de bloqueo axilar del plexo braquial y sus posibles complicaciones. La fosa axilar fue examinada bajo microscopio estereoscopico en 20 miembros superiores de diez fetos humanos. La edad de gestacion vario de 16 a 36 semanas. El arco axilar se observo unilateralmente en 2/20 especimenes. En ambos especimenes el musculo cruzo anteriormente el paquete neurovascular y termino en el tendon del musculo pectoral mayor y en el margen lateral del surco intertubercular. En un especimen el arco axilar se encontraba inervado por el nervio pectoral medial, mientras que en el otro no existia una determinado ramo del nervio. Se discuten los posibles efectos del arco axilar en las aplicaciones de bloqueo axilar del plexo braquial. Puede tener un significado potencial clinico y funcional, en lo que se refiere a la aplicacion de bloqueo axilar del plexo braquial y aademas producir efectos de complicaciones agudas.

Left Ventricular Mass in Normal Children and its Correlation with Weight, Height and Body Surface Area

La medicion ecocardiografica de la masa ventricular izquierda (LVM) se utiliza para el diagnostico de la hipertrofia ventricular izquierda en los ninos con diversas enfermedades cardiovasculares. Los objetivos de este estudio fueron establecer los valores normales de MVI en funcion del peso, altura y area de superficie corporal (BSA) en ninos y determinar las diferencias entre sexos. Se evaluaron 208 ninos (143 varones y 65 mujeres), con edades entre 1 dia a 14 anos de edad que presentaban enfermedades cardiovasculares. Se determinaron los valores interno al final del diastole ventricular izquierdo (LVIDd), el espesor de la pared posterior (LVPWd) y el tabique interventricular (IVSd) mediante el examen ecocardiografico en modo M. Utilizando estos valores, fue calculada la masa ventricular izquierda. Las diferencias de los valores LVIDd, LVPWd LVM entre ninos y ninas no fueron estadisticamente significativas. Observamos diferencias estadisticamente significativas entre los sexos en relacion con los valores IVSd y LVM/BSA. La masa ventricular izquierda y sus componentes presentaron una buena correlacion con la edad, peso, altura y BSA. Este estudio nos permitio conocer los limites superior e inferior de las dimensiones cardiacas, junto a la LVM obtenidas mediante ecocardiografia en ninos turcos normales de acuerdo con el BSA. Ademas, como los valores LVM/BSA muestran diferencias entre sexos en los ninos, el sexo se deberia tomar en consideracion al evaluar la hipertrofia ventricular izquierda.

Massive upper gastrointestinal bleeding from an accessory splenic artery mimicking isolated gastric varices

Knowledge of anatomical variations of coeliac trunk and its branches is important for surgeons and interventional radiologists planning surgical and radiological interventions. We describe a case of a 42-year-old male with an accessory splenic artery (ASA) originating from the left gastric artery (LGA) running in the wall of gastric fundus and mimicking isolated gastric varices, which was observed during endoscopy. Bleeding from this artery was massive and was managed with endovascular coil embolisation. Coeliac angiography of the patient with upper gastrointestinal bleeding showed that the coeliac trunk divided into 3 arteries: the LGA, the splenic artery, and the right hepatic artery. Additionally, the variations of ASA and the left hepatic artery arising from LGA, and the left and right inferior phrenic arteries arising from ASA were identified. This case is the first to be presented in the literature with ASA originating from LGA that was situated in the gastric wall where inferior phrenic arteries arose from the ASA.

Costanzo Varolio (1543–1575), who named the “pons”

Costanzo Varolio (sometimes spelled Constanzo Varolio) (latinised as Constantinus Varolius) (Fig. 1), son of Sebastiano Varolio, is a Renaissance neuroanatomist who lived in the sixteenth century. Varolio was an Italian citizen, born in 1543 in Bologna and died in Rome in 1575 [1–5]. Varolio studied philosophy at a local university and then graduated in 1567 with medical education at the University of Bologna (MD and PhD) [2, 6]. During his medical education, he took lessons from Julio Caesar Aranzio (1530–1589), who was a student of Andreas Vesalius (1514–1564) [3]. In 1569, he undertook the responsibility of teaching anatomy at the University of Bologna [6, 7]. In 1572, he went to Rome and it is thought that he lectured at Sapienza University. However, there is no record of this [4]. At the same time, he was the doctor of Pope Gregory XIII during this period. He died in Rome in 1575 [3, 4, 7]. His books

A sample of morphological eponym confusion: foramina of Stenson/Stensen

Morphological eponyms are structures named generally based on researchers who first defined formations, carrying their names. While a vast portion of morphological eponyms has been abandoned in time, some of these are still being used prevalently. Additionally, when the literature is reviewed, it may be seen that structures expressed by some eponyms differ. Moreover, spelling of eponyms may also vary in some aspects. An example of this case is: Foramina of Stenson/Stensen. The Danish scientist Niels Stensen (1638–1686) was born in Copenhagen. Stensen’s name has numerous alternate spellings. Even though he was born as Niels Stensen (sometimes spelled Steensen, Danish version), he prefer to use Nicolai Stenonis (academic and Latin name) while studying medicine. His name was spelled in different styles as Nicolaus Stenonis or Nicolas Sténon (French version), Niccolò Stenone (Italian version) and Nicolaus or Nicolas Steno (English version). Today, his name is known generally as Nicolaus or Nicolas Steno [6]. Niels Stensen described the lower opening of IC, known today as incisive foramen [1, 6]. As there are different ways of pronunciation of the name Niels Stensen, differences may be found in eponyms his name was given to. Incisive foramen is named as foramina of Stenson or foramina of Stensen. Additionally, as in examples of parotid duct (Stenon duct) and incisive foramen (foramina of Stenson/ Stensen), a person’s name may be used as an eponym in more than one structure [6]. Abandonment of prevalent usage of eponyms not only made learning easier, but also reduced the confusion in meaning. Furthermore, it may be seen that the upper opening of IC was not named in Terminologia Anatomica [3] and Dorland’s Illustrated Medical Dictionary [1], and this opening may be suitably named as nasopalatine foramen as it is between the nasal cavity and the palate. To the Editor,

Morphometric evaluation and surgical implications of the infraorbital groove, canal and foramen on cone-beam computed tomography and review of literature

BACKGROUND The purpose of this study is to evaluate the anatomy, morphometry, and variations of infraorbital groove (IOG), infraorbital canal (IOC) and infraorbital foramen (IOF) on the cone-beam computed tomography (CBCT) images and to investigate their relations with surrounding structures. METHODS IOG, IOC and IOF were evaluated retrospectively in CBCT images of 75 female (F) and 75 male (M) cases with a range of 18-65 years (F: 37.62 ± ± 13.55, M: 37.53 ± 15.87) by Planmeca Romexis programme. IOG, IOC and IOF were examined bilaterally (300 sides) in the cases. The 13 parameters were measured on these images in axial, sagittal and coronal planes. RESULTS There was a very weak positive correlation between the age and the angle between IOC and IOG (p = 0.015, r = 0.198), there was a weak positive correlation between the age and skin thickness (p = 0.001, r = 0.281), and there was no correlation between the age and other parameters. A total of 21 (7%) IOCs were detected in maxillary sinus, bilaterally in 6 cases and unilaterally in 9 cases (5 on the left, 4 on the right). In 1 case, bilaterally, IOC was separated 2 canals while running anteriorly in the maxillary sinus. The larger one was directed to IOF in its normal course and the smaller one was directed to lateral wall of nasal cavity and opened to the inferior nasal meatus in front of the opening of nasolacrimal duct. CONCLUSIONS We suggest that the parameters found in the present study may facilitate prediction of the location of the infraorbital nerve. Knowledge of this exact position in relation to easily measurable parameters may decrease the risk of infraorbital nerve injury during surgical approaches directed to this region and might serve as a guide during local anaesthetic interventions for dentistry, ophthalmology, plastic surgery, rhinology, neurosurgery and dermatology.