Taner Ziylan

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.

Radial artery graft for bypass of the maxillary to proximal posterior cerebral artery: An anatomical and technical study

Objective To examine the use of a radial artery graft for bypass of the maxillary artery (MA) to proximal posterior cerebral artery (PCA) as an alternative to the external carotid artery (ECA) to PCA anastomosis used in posterior circulation bypass surgery. Materials and methods The method was applied to five adult cadaver sides bilaterally. The MA was easily found 1–2 cm beneath the infratemporal crest after a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally, 2–3 cm posterolateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4-mm tipped drill. After sylvian fissure, the interpedincular and ambient cisternae were opened and the P2 segment of the PCA appeared. The graft was passed through the hole and dura to reach the P2 segment. Proximal to the infraorbital artery branch, the MA was freed from the surrounding tissue and transected. The proximal side of the radial artery graft was anastomosed end-to-end with the MA and the distal side was anastomosed end-to-side with the P2 segment of the PCA. Results The average diameter of the MA proximal to the infraorbital artery branch was 2.6±0.3 mm. The average diameter of the P2 was 2.2±0.2 mm. The average length of the graft was 47±5.2 mm. Conclusion As MA to proximal PCA bypass uses a short radial graft and as the calibers of the MA and PCA are >2 mm such a bypass may provide sufficient blood flow and represents a reasonable alternative to “ECA to PCA” bypass.

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.

An investigation of non-depolarizing muscle relaxants on embryonic development in cultured rat embryos

Background and objective: We have investigated the toxic and teratogenic effects of certain non-depolarizing muscle relaxants on embryonic development in cultured rat embryos. Methods: Rat embryos of 9.5 days were explanted and cultured in vitro for 48 h in rat serum. Whole rat serum was used as a culture medium for the control group while different concentrations of atracurium, cis-atracurium, rocuronium and mivacurium were added to rat serum for the experimental groups. Dose-dependent effects of these agents on embryonic developmental parameters were compared using morphological and biochemical methods. Each embryo was evaluated for the presence of any malformations. Results: When compared to the control embryos, the muscle relaxants significantly decreased all growth and developmental parameters dose dependently with an increase in overall dismorphology. Among these malformations, maxillary deformity was most frequently observed. These effects were observed in much lower doses with atracurium and cis-atracurium compared to those with rocuronium and mivacurium. Conclusions: Our results suggest that non-depolarizing muscle relaxants cause dose-dependent toxicity on rat embryos at concentrations much greater than those in clinical practice. Although, these agents seems to have a low potential for causing developmental toxicity during organogenesis, because of the lower toxic effects observed with rocuronium and mivacurium, these agents may be preferred when recurrent administrations are necessary for parturients.

Radial artery graft for bypass of the maxillary to proximal posterior cerebral artery

Objectives: Patients complaining with vertigo or dizziness, the pathology may be originated from central or peripheric compartment. These cases frequently apply to the Neurology, Neurosurgery, or ENT Clinics. The vertebro-basilar insufficiency is one of the most common pathologic causes of central vertigo or dizziness. This study aims to examine the use of a radial artery graft for bypass of the maxillary artery (MA) to proximal posterior cerebral artery (PCA) as an alternative to external carotid artery (ECA) to PCA anastomosis used for posterior circulation bypass surgery. Methods: This method was applied to 5 adult cadaver sides bilaterally. The MA was easily found 1−2 cm beneath to infratemporal crest, after a frontotemporal craniotomy and a zygomatic arch osteotomy. Extradurally 2−3 cm posterolateral to the foramen rotundum, a hole was drilled in the sphenoid bone with a 4−mm tipped drill. After sylvian fissure, interpedincular and ambient cisterns were opened, the P2 segment of the PCA appeared. The graft was passed through the hole and the dura to reach the P2 segment. Before giving the infraorbital artery (IOA) branch, the MA was freed from the surrounding tissue and transsected. The proximal side of the radial artery graft was anastomosed end-to-end with MA and distal side end-to-side with P2 segment of PCA. Results: The average diameter of the MA before giving the IOA branch was 2.6

An investigation of the origin, location and variations of the renal arteries in human fetuses and their clinical relevance.

pT 0.3 mm. The average diameter of the P2 was 2.2

An Analysis of Anatolian Human Femur Anthropometry

pT 0.2 mm. The average length of the graft was 47