Turan Koç

Evaluation of the origin and branching patterns of the iliolumbar artery and its implications on pelvic and vertebral surgery

Objectives: To evaluate the origin, distribution pattern, branches, and neighboring structures of the iliolumbar artery (ILA) concerning the anterolateral surgical approaches to the spine. Methods: This study was performed in the Anatomy Department of Medical School, Mersin University, Mersin, Turkey between 2014 and 2015. Pelvises of 11 male formalin-fixed human cadavers were dissected by anterior and posterior approaches under surgical microscope. The origins, distribution patterns, calibers, and distances to certain structures were measured. Results: The ILA was found as a single trunk on 17 sides arising either from the IIA (12 sides, 70.6%) or the PT (5 sides, 29.4%). The average caliber of those originated from the posterior trunk was significantly larger (p=0.010). The ILA started as a single trunk in 17 sides, while its lumbar and iliac branches separately originating from different arteries in 4 sides. The close relation of the posterior rami of both the lumbar and iliac branches with transverse process and spinal nerve were noted. Conclusion: Findings suggest that the ILA and its branches may have different and significant patterns, which may be crucial to consider during certain surgical procedures, such as far lateral disc herniation and posterior pelvic fixations.

Morphometric properties of the tensor fascia lata muscle in human fetuses

BACKGROUNDnIn neonatal and early childhood surgeries such as meningomyelocele repairs, closing deep wounds and oncological treatment, tensor fasciae lata (TFL) flaps are used. However, there are not enough data about structural properties of TFL in foetuses, which can be considered as the closest to neonates in terms of sampling. This studys main objective is to gather data about morphological structures of TFL in human foetuses to be used in newborn surgery.nnnMATERIALS AND METHODSnFifty formalin-fixed foetuses (24 male, 26 female) with gestational age ranging from 18 to 30 weeks (mean 22.94 ± 3.23 weeks) were included in the study. TFL samples were obtained by bilateral dissection and then surface area, width and length parameters were recorded. Digital callipers were used for length and width measurements whereas surface area was calculated using digital image analysis software.nnnRESULTSnNo statistically significant differences were found in terms of numerical value of parameters between sides and sexes (p > 0.05). Linear functions for TFL surface area, width, anterior and posterior margin lengths were calculated as y = -225.652 + 14.417 × age (weeks), y = -5.571 + 0.595 × age (weeks), y = -4.276 + 0.909 × age (weeks), and y = -4.468 + 0.779 × age (weeks), respectively.nnnCONCLUSIONSnLinear functions for TFL surface area, width and lengths can be used in designing TFL flap dimensions in newborn surgery. In addition, using those described linear functions can also be beneficial in prediction of TFL flap dimensions in autopsy studies.

Morphometric properties of the facial nerve in fetal temporal bones

OBJECTIVESnThe main aim of the study was to examine the development and course of the facial nerve within fetal temporal bones from an anatomical and neuro-otological perspective.nnnMETHODSnThe study was conducted on 32 temporal bones from obtained fetuses (7 females, 9 male), on a mean gestational age of 26.75u202f±u202f4.36 (range, 20-34) weeks from the collection of the Anatomy Department of Medicine Faculty. All the measurements were collected with a digital image analysis software.nnnRESULTSnNeither male/female nor right/left significant differences were observed in relation with the algebraic data of the segment lengths and angles of the facial nerve (pxa0>xa00.05). Linear functions for meatal, labyrinthine, tympanic, and mastoid segment lengths of the facial nerve were calculated as: yxa0=xa0-1.206xa0+xa00.200 × Age (weeks), yxa0=xa0-1.868xa0+xa00.153 × Age (weeks), yxa0=xa0-2.327xa0+xa00.325 × Age (weeks), and yxa0=xa0-1.507xa0+xa00.246 × Age (weeks), respectively. In addition, linear functions for first and second genu angles were calculated as: yxa0=xa0105.475-0.117 × Age (weeks) and yxa0=xa0140.446-0.042 × Age (weeks), respectively.nnnCONCLUSIONnThe regression equations and the scatter plot with increment curve, representing the growth dynamics of the facial nerve can be used for estimating its lengths and for understanding its development. The data suggest that there is a dramatic change transition from fetal life to the gathered data of adulthood in the length of meatal and mastoid segments as well as in the second genu angle; in addition, there is a partial change in the length of labyrinthine and tympanic segments as well as in the first genu angle.

Quantitative assessment of the growth dynamics of the teres major in human fetuses

PurposeThe main objective of the study was to examine the use of teres major (TM) as a flap in the pediatric surgeries from an anatomical perspective by: (1) revealing the growth dynamics of the developing TM; (2) assessing the possible interconnecting structures between TM and latissimus dorsi (LD); (3) exposing the innervation patterns of TM in human fetuses.MethodsStudy was conducted on 50 fetuses (26 females and 24 males), on a mean gestational age of 22.86u2009±u20093.21 (range 18–30) weeks. All the measurements were collected with a digital caliper and a digital image analysis software. Additionally, structural relations between TM and LD were examined in detail and further classified.ResultsNo significant difference of side and sex was detected on TM measurements (pu2009>u20090.05). Linear functions for the surface area, width, length of the superior and inferior margins of TM were detected as follows: yu2009=u2009−u2009257.142u2009+u200918.334u2009×u2009age (weeks), yu2009=u2009−u20095.497u2009+u20090.545u2009×u2009age (weeks), yu2009=u2009−u20091.621u2009+u20091.068u2009×u2009age (weeks), and yu2009=u2009−u20092.147u2009+u20091.284u2009×u2009age (weeks), respectively. As classified in five types, a number of 33 muscular or tendinous connections between TM and LD were detected. Musculo-tendinous slips from TM to triceps brachii (TB) were evident in four sides. Innervation of TM was observed to be providing by the lower subscapular nerve in all the cases.ConclusionFirst, linear functions, representing the developing fetal morphometry obtained by our study can be adapted for estimating the morphometric of this muscle in early childhood. Besides, acknowledging the diverse appointments of TM with the surrounding muscles such as LD and TB may facilitate the prevention of neurovascular structures and the application of surgical procedures during tendon transfers. In brief, our findings are highly potent to bring the attention of pediatric surgeons.

Replaced right hepatic artery and interlobar bridge of liver with unusual arterial supply of IVth segment

s 101 Conclusion: Increased pulse pressure and increased aortic stiffness were associated with the severity of WML, assessed with both Fazekas score and a quantative hyperintenstity segmentation method. Age is highly associated with aortic stiffness and cerebral small vessel disease. P27 REPLACED RIGHT HEPATIC ARTERY AND INTERLOBAR BRIDGE OF LIVER WITH UNUSUAL ARTERIAL SUPPLY OF IVTH SEGMENT Mehtap Yuksel , Turan Koc , Sezgin Ilgi 1 Near East University, Faculty of Medicine, Department of Anatomy, Nicosia, Cyprus Mersin University, Faculty of Medicine, Department of Anatomy, Mersin, Turkey A replaced right hepatic artery (rRHA) arising from the superior mesenteric artery and an interlobar parenchymal bridge over the sagittal fissure of liver have been observed on a 64 year old formalin-fixed male cadaver in the anatomy laboratory. As we followed a detailed segmental anatomy, encountered an arterial distribution on the segment IV featuring adifferent pattern from the literature so far. According to our observations, the segment I is supplied by both left (LHA) andmiddle (MHA) hepatic arteries; the segments II and III are supplied by the LHA while the segment IV is supplied by both the MHA and rRHA. The segments V-VIII are supplied only by the rRHA. Our case emphasizes the importance of arterial variations of liver once again in terms of the surgical procedures during the liver transplantation, hepatic tumors, and etc. Our discussion particularly focuses to the arterial supply of the segment IV and possible complications it may cause during/after the liver operations. References 1-Ghosh SK. Variations in the origin of middle hepatic artery: a cadaveric study and implications for living donor liver transplantation. Anat Cell Biol 2014;47:188e95 2Bismuth H. Surgical anatomy and anatomical surgery of the liver. World J Surg 1982;6:3e9 3-Jin GY, Yu HC, Lim HS, Moon JI, Lee JH, Chung JW, Cho BH. Anatomical variations of the origin of the segment 4 hepatic artery and their clinical implications. Liver Transpl 2008;14:1180e4 P28 DETERMINANTS OF ARTERIAL STIFFNESS AS MARKER OF EARLY VASCULAR AGING IN PHYSICIANS POPULATION Elena Shavarova , Eldar Kazahmedov , Artemiy Orlov , Zhanna Kobalava 1 RUDN University, Russia Petr Telegin Company, Russia Objective: To analyze determinants of arterial stiffness in physician’s population. Methods: Observational multicenter study of doctor’s vascular health conducted in 12 Russian cities (VICTORIA study). Demographics; smoking status; anamnesis of arterial hypertension (AH) with/without therapy, medications, established CV, renal diseases, diabetes mellitus; cholesterol and glucose level were registered. Arterial stiffness and vascular age was assessed using BPLab device with Vasotens technology (Petr Telegin Company, Nizhny Novgorod, Russia). Arterial stiffness was defined as an elevation of pulse pressure (PP)> 60mmHg, PWV> 10 m/s. Results: 464 individuals were included (247 normotensives (mean age 44 yrs) and 237 with AH (mean age 58 yrs)). Mean PP was 46.0 9.8 mm Hg in normotensive group and 58.6 17.4 mm Hg in group with AH (p< 0.001). Mean PWVao was 10.9 2.0 m/s and 12.5 2.5 m/s in groups without and with AH, respectively (p< 0.001). PP> 60mm Hg had 11% subjects without AH and 43% with elevated blood pressure (BP) (p< 0.001). PWVao >10 m/s had 68% of normotensive subjects and 92% of hypertensive patients (p< 0.001). PWVao correlated with brachial systolic (rZ 0,42, p< 0.05) and diastolic BP (rZ 0,38; p< 0.05), central systolic (rZ 0,45, p< 0.05) and diastolic BP (rZ 0,41; p< 0.05), age (rZ 0,37, p< 0.05), heart rate (rZ 0,41, p< 0.05). There was association between elevated PWVao and body mass index (rZ 0,39, p< 0.05). In a multiple linear regression model, independent determinants of PWV were systolic BP (bZ 0,29, p< 0.001), body mass index (bZ 0,19, p< 0.001). Conclusions: High PWVao measured by BPLab device with Vasotens technology is characterized physician’s population with and without AH. The main determinants of PWVao are systolic BP and body mass index. P29 TOTAL LONGITUDINAL DISPLACEMENT (TLOD) OF THE COMMON CAROTID ARTERY (CCA) DOES NOT DIFFER BETWEEN PATIENTS WITH MODERATE OR HIGH CARDIOVASCULAR RISK (CV) AND PATIENTS AFTER ACUTE MYOCARDIAL INFARCTION (AMI) Urt _ e Gargalskait _ e , Pranas Serpytis , Karolis Azukaitis , Rokas Navickas , Vilma Dzenkeviciute , Jolita Badariene , Zaneta Petrulioniene , Kristijonas Cesas 1 Faculty of Medicine, Vilnius University, Lithuania Vilnius University Hospital Santaros Klinikos, Lithuania Background: Total longitudinal displacement (tLoD) of the common carotid artery (CCA) wall is a novel ultrasound marker of vascular function that can be evaluated using modified speckle tracking techniques. Decreased CCA tLoD has already been shown to be associated with diabetes and was shown to predict one year cardiovascular outcome in patients with suspected coronary artery disease (CAD). The aim of our study was to evaluate if CCA tLoD differ between patients with moderate or high cardiovascular (CV) risk and patients after recent acute myocardial infarction (AMI). Methods: 49 patients (54 6 years) with moderate or high CV risk and 42 patients (58 7 years) after recent AMI were included. All patients were nondiabetic. CCA tLoD was evaluated using GE EchoPAC speckle tracking software and expressed as mean of both sides. Data on systolic blood pressure, total and high density lipoprotein (HDL) cholesterol levels, high sensitivity Creactive protein (hsCRP) level, smoking status and family history of early CV events was evaluated and assessed for association with CCA tLoD. Results: tLoD of CCA did not differ between patients with moderate or high CV risk and patients with very high CV risk after MI (0.265 0.128 mm vs. 0.237 0.103 mm, p> 0.05). Lower tLoD was associated with lower HDL cholesterol levels (rZ 0.211, pZ 0.04) and male gender (0.228 0.1 vs. 0.297 0.134, pZ 0.01). Conclusions: tLoD of CCA did not differ between patients with moderate or high CV risk and patients with very high CV risk after AMI. However, lower CCA tLoD was significantly associated with low HDL cholesterol levels and male gender. P30 THE ROLE OF NOVEL BIOMARKERS IN ARTERIAL STIFFNESS, AND IN PREDICTING FURTHER VASCULAR EVENTS AFTER TIA AND LACUNAR

Bilateral persistent sciatic vein: report of a case with developmental, histological and clinical aspects

ObjectiveBilateral large variant veins were encountered in the lower extremity. It was aimed to identify the structural characteristics of this rare case and then, regarding the structural features, to overview its formation process and denomination.Material and methodDuring the routine dissection of a 93-year-old male cadaver, bilateral large variant veins were found at the thigh. Valves of the veins were examined and evaluated together with the vascular wall histology.ResultsThe variant vein was loosely attached to the sciatic nerve by fibrous tissue and had anastomoses with the popliteal vein in the popliteal fossa on each side. The popliteal veins were hypoplastic on both sides. The right variant vein was passing through the fibers of the adductor magnus muscle 56.2xa0mm above the adductor hiatus, which corresponds to the third perforating branch of deep femoral vein. The left one was turning to the front over the adductor magnus muscle, at the lower border of quadratus femoris muscle. The left variant vein was corresponding to the descending branch of the medial circumflex femoral vein. Both variant veins had one incomplete and three well-developed valves.ConclusionIn accordance with the findings, the variant vein was concluded to be an embryonic remnant, rather than an acquired one subsequent to any obstruction of the femoral vein. Regarding their connection with the popliteal vein but not with the internal iliac vein, both variant veins were denominated as “lower type persistent sciatic vein”. Such a variation would be important with respect to the risk of complication during popliteal sciatic nerve blockade.