Clinician's perspective regarding medication adherence in patients with obstructive lung diseases and the impact of COVID-19.

OBJECTIVE: Failure to achieve high levels of medication adherence in obstructive lung diseases is a major cause of uncontrolled disease. The purpose of this study is to reveal clinicians' opinions on the level of patient adherence and the change in adherence during the COVID-19 pandemic. METHODS: A questionnaire containing multiple-choice questions about treatment adherence in patients with obstructive lung diseases was voluntarily applied to doctors working in a tertiary hospital for chest diseases. RESULTS: Eighty-one doctors (mean age, 37.2 years [standard deviation, 9.7 years]; 57 (70.4%) women) answered the questionnaires. Almost all clinicians participating in the study reported that they always or frequently asked patients if they adhered to treatment. Most clinicians think that in 20-50% of patients with asthma and less than 20% of patients with chronic obstructive pulmonary disease, a decrease in medication adherence appears in the first year of treatment. Most clinicians think the main reason for patients with obstructive lung diseases not adhering is patients' reluctance to be treated regularly. Regarding the impact of the COVID-19 pandemic on patients' drug adherence, 43.2% of clinicians observed that adherence increased after the start of the pandemic. CONCLUSIONS: Adherence to medication is not at the desired levels in patients with obstructive lung diseases. However, when faced with a serious health threat, such as the COVID-19 pandemic, patients realize the severity of their illness and begin using their treatments more regularly.

Performance of pulmonary embolism severity index in predicting long-term mortality after acute pulmonary embolism.

OBJECTIVE: In this study, we aimed to evaluate the accuracy of the original and simplified pulmonary embolism (PE) severity index (PESI) to predict all-cause mortality after 30 days of acute PE diagnosis up to five years within consecutive sub-periods. METHODS: Adult patients diagnosed with acute PE between January 1, 2003, and June 30, 2013, were retrospectively included. Data on baseline characteristics and mortality during a five-year follow-up were collected. RESULTS: The study included 414 patients (Male/Female=192/222). The median age at diagnosis was 61.5 (minimum-maximum, 18-93) years. Mortality rates were 13.3% at 30 days, 21.8% at 90 days, 32.6% at one year, and 51.0% at five years. Both stratification into risk classes according to the original PESI and low vs. high-risk classification of original and simplified PESI were significantly correlated with the 30-day, 31-90-day, 91-day-one-year, and one-five-year mortality. Significant PESI predictors for mortality were history of cancer [hazard ratio (HR): 3.31, 95% confidence interval (CI): 1.64-6.68; p=0.001] and heart failure (HR: 2.35, 95% CI: 1.04-5.32, p=0.041) at 31-90-day, history of cancer (HR: 5.45, 95% CI: 2.86-10.40, p<0.001) at 91-day-one-year, advancing age (HR: 1.04, 95% CI: 1.02-1.06, p<0.001) and history of cancer (HR: 5.53, 95% CI: 3.41-8.98, p<0.001) at one-five-year after acute PE diagnosis. CONCLUSION: All-cause long-term mortality in high-risk patients with acute PE according to original or simplified PESI significantly increased up to five years of follow-up. This survival disadvantage was mainly related to cancer and comorbidities rather than acute clinical manifestations. Future prospective studies are needed to demonstrate the effect of various comorbidities on long-term mortality in these patients.

Evaluation of Acromegaly patients with sleep disturbance related symptoms.

BACKGROUND AND OBJECTIVES: It is known that the prevalence of obstructive sleep apnea (OSA) is increased in acromegaly. Craniofacial anomalies, macroglossia, and thickening of the laryngeal wall caused by the increase in soft tissue in these patients lead to OSA. Also, the increase in growth hormone can trigger central apnea by causing a decrease in respiratory drive. Determining the polysomnographic characteristics of acromegaly patients is important to reveal the effect of these mechanisms. METHODS: The demographic and polysomnographic characteristics of 33 acromegaly patients who underwent polysomnography (PSG) with suspicion of sleep disorders between 2011 and 2018 in the sleep laboratory of our hospital were retrospectively analyzed. One of the patients was excluded from the analysis because PSG was performed in the postoperative period. The remaining 32 patients with active acromegaly were grouped according to their gender and the presence of OSA and compared with statistical methods in terms of polysomnographic and clinical features. RESULTS: OSA (AHI>5) was detected in 78.1% of 32 active acromegaly patients (18 females, 14 males) who underwent PSG with suspicion of sleep-disordered breathing. Moderate-severe OSA (62.5%) was found in most patients, and there was no difference between the sexes in terms of OSA detection rate and OSA severity. Respiratory events appear to be predominantly obstructive hypopneas. Also, the polysomnographic features of female and male acromegaly patients with OSA were found to be similar. It is seen that the OSA group is similar to the group with simple snoring in terms of body mass index (BMI), but is statistically significantly older (p=0,007). A positive correlation was found between age and AHI in pairwise correlation analysis (r:0,426 p:0,015, respectively). CONCLUSION: Considering that the prevalence of OSA in the population is approximately 5%, our results show that the risk of OSA in acromegaly increases, and obstructive pathways are effective in this increase. The probability of OSA occurrence and polysomnographic features between the genders are similar. Although the median BMI of the patients with and without OSA was similar, the median age was higher in the group with OSA, middle-aged acromegaly patients should be evaluated in terms of OSA even if there is no obvious obesity.

Obstructive sleep apnea is a determinant of asthma control independent of smoking, reflux, and rhinitis.

Background: Asthma control is defined as to what extent manifestations of asthma can be observed in a patient or have been reduced or removed by treatment. Regular use of asthma treatments, correct inhaler technique, adequate information provided about the patient's diseases and medicines, and patient-clinician collaboration aid asthma control. Asthma shares risk factors and links in the pathogenesis with obstructive sleep apnea (OSA), and OSA may aggravate asthma symptoms. Objective: To assess the risk of OSA for asthma control. Methods: The study was carried out in subjects with asthma who were followed up at specific time points and who used asthma medication regularly and with an appropriate inhaler technique. An asthma control test and a questionnaire were used to determine the asthma control levels and OSA risk of the subjects. Results: With regard to the questionnaire scoring, 77 of 137 subjects with asthma had a low OSA risk and 60 had a high OSA risk. The proportion of the subjects with a high OSA risk (p < 0.001) and were smokers (p = 0.020) were significantly higher in the subjects with uncontrolled asthma than in those with controlled asthma. Logistic regression analysis showed that the variables that affect asthma control status were the risk of OSA and obesity. The subjects with a low OSA risk were more likely to have controlled asthma than those with a high OSA risk (odds ratio 7.896 [95% confidence interval, 2.902-21.487]; p < 0.001). Conclusion: In the subjects with asthma and who adhered to therapy and used inhalers with the correct technique, a high risk of OSA was associated with poor control of their asthma. This association was independent of other factors, including rhinitis, gastroesophageal reflux, and smoking.

Programmed death ligand-1 expression levels, clinicopathologic features, and survival in surgically resected sarcomatoid lung carcinoma.

AIM: To determine the programmed death ligand-1 (PD-L1) expression rates in sarcomatoid lung carcinomas and to compare clinicopathologic features and survival rates of PD-L1-positive and negative patients. METHODS: PD-L1 expression was evaluated in 65 surgically resected sarcomatoid carcinomas. The clinicopathologic features of cases with PD-L1-positive and negative tumors were compared. Kaplan-Meier survival analysis was performed. Multiple Cox proportional hazard regression analysis was performed to determine independent predictors of overall survival. RESULTS: PD-L1 antibody positivity was found in 72.3% of surgically resected sarcomatoid lung carcinomas. Regarding histopathologic subtypes, PD-L1 expression was positive in 80.4% of pleomorphic carcinomas, 62.5% of spindle- and/or giant-cell carcinomas, and 16.7% of carcinosarcomas. Pleural invasion was observed in 68.1% of PD-L1-positive cases and 27.8% of PD-L1-negative cases (P = 0.008). No difference in survival was found between PD-L1-positive and -negative tumors. The only factor significantly associated with poor survival was the pathological stage of the tumor. CONCLUSIONS: This study reveals a high rate of PD-L1 positivity in a large number of sarcomatoid lung carcinoma cases with pleomorphic carcinoma, spindle- and/or giant-cell carcinoma, and carcinosarcoma subtypes. The only significantly different clinicopathologic feature in PD-L1-positive cases is pleural invasion. PD-L1 positivity is not a significant predictor of survival in sarcomatoid lung carcinomas.

Clinician's perspective regarding medication adherence in patients with obstructive lung diseases and the impact of COVID-19

SUMMARY OBJECTIVE: Failure to achieve high levels of medication adherence in obstructive lung diseases is a major cause of uncontrolled disease. The purpose of this study is to reveal clinicians' opinions on the level of patient adherence and the change in adherence during the COVID-19 pandemic. METHODS: A questionnaire containing multiple-choice questions about treatment adherence in patients with obstructive lung diseases was voluntarily applied to doctors working in a tertiary hospital for chest diseases. RESULTS: Eighty-one doctors (mean age, 37.2 years [standard deviation, 9.7 years]; 57 (70.4%) women) answered the questionnaires. Almost all clinicians participating in the study reported that they always or frequently asked patients if they adhered to treatment. Most clinicians think that in 20-50% of patients with asthma and less than 20% of patients with chronic obstructive pulmonary disease, a decrease in medication adherence appears in the first year of treatment. Most clinicians think the main reason for patients with obstructive lung diseases not adhering is patients' reluctance to be treated regularly. Regarding the impact of the COVID-19 pandemic on patients' drug adherence, 43.2% of clinicians observed that adherence increased after the start of the pandemic. CONCLUSIONS: Adherence to medication is not at the desired levels in patients with obstructive lung diseases. However, when faced with a serious health threat, such as the COVID-19 pandemic, patients realize the severity of their illness and begin using their treatments more regularly.

[What is the role of montelukast in asthma treatment?] / Astim tedavisinde montelukastin yeri nedir?

Asthma is a common chronic pulmonary disease worldwide. Inhaled glucocorticoids are the most effective therapeutic agents in treatment of asthma and are therefore the first drug of choice in asthma treatment. Antileukotrienes are alternative controller drugs in management of asthma especially in patients who cannot use inhaled glucocorticoids effectively due to compliance problems or poor inhaler techniques.

Does spirometric tests meet the acceptability criteria? Data from a tertiary chest hospital in Turkey.

INTRODUCTION: First step is to evaluate the quality of the test in interpreting spirometries. International societies have defined the acceptability criteria for spirometric tests. With this study, it was aimed to evaluate spirometric tests in terms of compliance with international acceptability criteria and to determine error types. MATERIALS AND METHODS: Spirometric manoeuvres held at a tertiary chest diseases hospital were evaluated as to whether the acceptability criteria of "American Thoracic Society/European Respiratory Society (ATS/ERS)" guideline were maintained or not. Errors determined were classified as unexplosive start of expiration, submaximal effort, cough, closure of glottis, missing closure of the loop ring and early termination of expiration. RESULT: Among tests evaluated (n= 510), 276 (54.1%) belonged to female and 234 (45.9%) to male subjects. Average age of subjects was 56.1 ± 15.0 years. It was noted that 318 (62.4%) of the tests met acceptability criteria, whereas 192 (37.6%) did not. The most frequently noted error type is submaximal effort by 30.2% followed by missing closure of the loop, early terminaton of expiration, coughing, unexplosive start of expiration and closure of glottis. In the tests whose spirometric maneuvers did not meet the criteria, the mean age of the patients was significantly higher than in the appropriate tests. When the cases were grouped according to their age, it was observed that the rate of conformity of spirometric examinations decreased significantly as the age range increased. CONCLUSIONS: Within this study it is the first time in our country that evaluation of spirometric studies has been made to see the rate of conformity with international standarts. Although it is thought that spirometric examinations are not technically appropriate in clinical practice throughout our country, there is no data in the literature. Although the center where the study is conducted is a tertiary chest diseases hospital, the data obtained reveal that in spirometric evaluations, a substantially non-standard examination was performed.

Clinical, sociodemographic and tobacco-use factors associated with smoking cessation rates at three years follow-up, Ankara, Turkey.

INTRODUCTION: Smoking is a well-known major cause of early preventable mortality and morbidity. Maintenance of smoke-free status is important after a smoking cessation attempt. The present study aims to compare the sociodemographic and clinical characteristics of subjects participating in a smoking-cessation program, according to the duration of smoking cessation. METHODS: A study was conducted in 261 smokers who had attended a smoking cessation clinic in a tertiary hospital, in Ankara, Turkey. The smoking status of the subjects at three years follow-up after participating in the smoking-cessation program was assessed. Sociodemographic, employment, environmental, smoking-related, health and clinical characteristics of subjects were compared according to the smoking cessation duration. RESULTS: Marital status, having a child, absence of household smoking and lower levels of nicotine dependence were significantly higher in quitters, and anxiety was lower. Parameters that significantly differed between subjects that were and were not abstinent for >36 months were marital status (p<0.001), childbearing status (p=0.007), household smoking (p<0.001), age of smoking initiation (p=0.02), psychiatric illness history (p=0.01), and number of follow-up visits (p<0.001). The number of follow-up visits at the smoking cessation clinic was an important factor of quitting and maintenance of quit status. CONCLUSIONS: Family and home environment as well as smoking-related and mental health characteristics influenced maintenance of long-term smoking cessation. Characteristics such as sociodemographic, clinical and smoking-related conditions should be considered in smoking cessation interventions. Personalized treatment strategies and follow-up visits at the smoking cessation clinic should be planned for maintenance of smoking cessation.

Triple test with tumor markers CYFRA 21.1, HE4, and ProGRP might contribute to diagnosis and subtyping of lung cancer.

BACKGROUND AND AIM: Early diagnosis and histological subtyping are important issues in the management of patients with lung cancer (LC). The aim of this study is to investigate the diagnostic value of a panel of serum tumor markers in newly diagnosed patients with LC. METHODS: Venous blood samples were collected from 99 patients with LC (42 adenocarcinoma, 35 squamous, and 22 small cell carcinoma) and 30 patients with benign lung disease. Progastrin releasing peptide (ProGRP), squamous cell carcinoma antigen (SCCAg), cytokeratin 19-fragments (CYFRA 21.1), human epididymis protein 4 (HE4), Chromogranin A (CgA) and neuron specific enolase (NSE) levels were measured. The diagnostic value of the biomarkers was assessed with ROC curve analyses; the area under the curve (AUC) was calculated. RESULTS: Serum CYFRA 21.1, ProGRP, SCCAg, NSE levels were significantly higher in LC patients. While ProGRP levels were higher (p = 0.009) in SCLC; CYFRA 21.1 and SCCAg levels were higher in NSCLC (p = 0.019 and p = 0.001, respectively). The sensitivity and specificity of tumor markers were 72%, 83% for CYFRA 21.1; 70%, 57% for HE4; 18%, 93% for ProGRP; 43%, 77% for SCCAg; 54%, 53% for CgA; 73%, 50% for NSE. CYFRA 21.1 (p < 0.001, r = 0.394), HE4 (p = 0.014, r = 0.279) and CgA (p = 0.023, r = 0.259) levels were positively correlated with tumor stage in NSCLC. CgA levels were significantly higher in extensive stage SCLC (p = 0.004). CYFRA 21.1 had the highest diagnostic value for LC (AUC = 0.865). When it is combined with HE4, diagnostic value increased (AUC = 0.899). ProGRP had the highest diagnostic value (AUC = 0.875, p < 0.001) for discriminating SCLC from NSCLC. CONCLUSION: A panel of three tumor markers CYFRA 21.1, HE4 and ProGRP may play a role for discriminating LC from benign lung disease and subtyping as SCLC.

Comparison of Three Methods Used for Estimating Area of Foramen Magnum.

OBJECTIVE: To compare whether there are any differences between the 3 methods used for measure area of foramen magnum (FM) in skulls. METHODS: The FMs of 150 skulls were examined. Antero-posterior diameter, transverse diameter were measured using by Vernier caliper. The area of the FM was calculated by using 2 different formulas as described previously by Radinsky and Teixeira.The authors also applied stereological assessment method for estimating the surface area of FMs. The area was calculated 3 times manually using stereological point grid system for each skull.The authors compared the mean surface area of FMs obtained from each of these 3 methods estimating surface area of FMs whether there were any significant differences in between their results. RESULTS: The mean areas of the FMs estimated according to Teixeria formula, Radinsky formula, and Cavalieri stereological method were respectively as follows: 790.47 ±â€Š99.86 mm, 783.66 ±â€Š99.34 mm, and 748.06 ±â€Š100.19 mm. The authors observed significant differences (P < 0.05) in between the mean surface areas of FMs obtained from each of these 3 methods used for estimating the area. CONCLUSION: There were significant differences (P < 0.05) in between the mean surface areas of FMs obtained from each of these 3 methods used for estimating the area.

The Morphological Grading and Comparison of Sutural Patency Among Cranial Sutures in Dry Human Skulls.

OBJECTIVE: To investigate the degree of fusion (patency) among cranial sutures in human dry skulls in the Anatolia. METHODS: One-hundred fifty-eight human dry skulls that were accepted as adults according to the teeth eruption were macroscopically examined and photographed with Canon 400B (55 mm objective). The grades of fusion of coronal, sagittal, and lambdoid were quantitatively analyzed by using the modified grading scale. According to the extent of patency, the sutures were graded as grade-0 (open), grade-1 (fused but not obliterated), grade-2 (50%< obliterated), grade-3 (50% > obliterated), and grade-4 (100% obliterated). The authors determined and compared the rate for each grade of sutural patency on coronal, sagittal, and lambdoid sutures. RESULTS: The cranial sutures of 4 cranii (4/158; 2.53%) had grade-4 fusion, whereas there were no any cranii with sutures of grade-0 fusion. The number of each grade of fusion among cranial sutures of 158 skulls, in descending order, was as follows: 171 (grade-3), 145 (grade-1), 133 (grade-2), and 25 (grade-4). The grade-4 fusion was significantly less observed than the others. The grade-1 and grade-4 fusion of lambdoid sutures were established as the most (66/41.8%) and least (5/3.2%) common fusions among cranial sutures, respectively. The frequencies of each grade of fusion for each cranial suture were determined in a descending order: coronal (grade-3 > 2 > 1 > 4), sagittal (grade-3 > 2 > 1 > 4), and lambdoid sutures (grade-1 > 3 > 2 > 4). The frequency of grade-1 fusion of lambdoid suture (66/41.8%) was significantly different when compared with coronal (39/24.7%) and sagittal sutures (40/25.3%), respectively. CONCLUSION: The grades of fusion (or sutural patency) vary among cranial sutures.

Morphological and Morphometric Analysis of Foramen Magnum: An Anatomical Aspect.

OBJECTIVE: To investigate the detailed morphological and morphometric analysis of foramen magnum (FM) in dry cranii. METHODS: One hundred fifty skulls of unidentified sex were macroscopically examined and were photographed with Canon 400B (55 mm objective). According to tooth eruption of the skulls, they were accepted as adults. None of the examined skulls showed signs of prior cranial surgery, malformation, or trauma. The evaluated study parameters that were recorded with Vernier caliper in millimeter were as follows: antero-posterior diameter from Basion to Opisthion, transverse diameter (largest distance between the lateral margins of the FM), and the shape of the FM (Fig. 1). The shape of the FM was determined according to FM index that was calculated by dividing antero-posterior diameter by transverse diameter. When FM index was found greater than or equal to 1.2, the foramen was accepted to be oval in shape. Whereas the FM index was found less than 1.2, the foramen was accepted to be round in shape The area of the FM was calculated by using 2 different formulas as described previously by Radinsky (/4 × π × w × h) and Teixeira (π × {(h + w)/4}2), and "π" was accepted as 3.14 in both formulas. RESULTS: The results of descriptive statistics and areas of the FMs were presented in Table 1. The mean antero-posterior diameter and transverse diameter of anteroposterior diameter by transverse diameters were found as 34.38 ±â€Š2.38 and 28.95 ±â€Š2.19, respectively. The mean area of the FMs estimated by Teixeria formula was determined significantly larger than the mean area of the FMs estimated by Radinsky formula (P <0.001). According to estimated FM index of the 150 adult dry skulls, 87 (58%) of skulls were described as being round in shape and 63 (42%) of skulls were described as being oval in shape (Fig. 1). CONCLUSION: The surgeons must comprehend regarding the detailed morphological and morphometric features of FM to avoid vital complications during the surgical procedures.

Effect of training by a physician on dynamics of the use of inhaler devices to improve technique in patients with obstructive lung diseases.

BACKGROUND: Pharmacotherapies for obstructive lung diseases are dependent on agents delivered via inhaler devices, and the correct technique is essential for efficiency of these drugs. OBJECTIVE: To determine the rate of incorrect inhaler techniques among patients with pulmonary diseases and the efficacy of delivering physician-provided training to patients by letting them practice with their inhaler devices. METHODS: Patients ages ≥18 years with asthma, chronic obstructive pulmonary disease, or asthma chronic obstructive pulmonary disease overlap syndrome were enrolled. At the first visit, the patients were requested to use their own inhalers that they were currently on for initial evaluation of their inhalation technique. Correct and incorrect techniques were determined according to steps previously described in the literature. At the same visit, the physician provided practical training on faulty techniques detected, and a control visit was scheduled. RESULTS: The study involved 108 patients, and 158 different inhalation techniques were assessed. Types of inhaler devices included in the study were metered-dose inhaler and five types of dry-powder inhalers. Fifty-six incorrect practices (35.4%) were noted. Although 64 patients (59.3%) used all of their inhaler devices with the correct technique, 44 (40.7%) used one or more inhalers inappropriately. At the control visit, the patients who misused their inhalers decreased significantly, to 8.3% (p < 0.001). The faulty technique ratio was decreased to 7.0%, which yielded the success of practical training as 80.4%. CONCLUSION: Incorrect inhaler technique is still a problem for patients with obstructive lung diseases even in urbanized areas. Physician-provided practical training on the use of inhaler devices was an effective tool in the correction of inhaler techniques.

Coexistence of Wormian Bones With Metopism, and Vice Versa, in Adult Skulls.

OBJECTIVE: The aim of the study is to investigate coexistence of Wormian bones with metopism, and vice versa, in adult skulls. MATERIALS AND METHODS: A total of 160 dry adult human skulls of unknown sex and ages were randomly selected from the Gross Anatomy Laboratory of Medical School of Dokuz Eylul University. The skulls were examined for presence of metopism, Wormian bones (WB), and coexistence of WBs with metopism and vice versa. Topographic distribution of the WBs was macroscopically evaluated within the skulls including metopism. The photographs were being taken with Canon 400B (55 mm objective). RESULTS: The frequency of metopism and WBs in 160 skulls is 7.50% (12/160) and 59.3% (95/160), respectively, P < 0.05 (). The incidence of coexistence of WBs with metopism was found as 11 of 12 skulls (91.66%), whereas the incidence of coexistence of metopism with WBs was found as 11 of 95 skulls (11.58%), P < 0.05 (). There were totally 23 sutures including WBs in 11 skulls, which had metopism (). The number (%) of metopic skulls for each specific suture including WBs were found as: 11 lamdoid sutures in 7/11 (63.63%) skulls, 4 lambda in 4/11 (36.36%) skulls, 2 asterion in 2/11 (18.18%) skulls, 1 squamous in 1/11 (9.09%) skull, 2 sagittal in 2/11 (18.18%) skulls, and 3 parieromsatoid sutures in 2/11 (18.18%) skulls (). The distribution of these 23 WBs in sutures of 11 skulls including metopisms is determined as follows: 11/23 (47.82%) WBs at lambdoid sutures [5/23 (21.74%) at the right lambdoid sutures and 6/23 (26.08%) at the left lambdoid sutures, and 4 pair of 11 WBs bilaterally located]; 4 (17.39%) WBs at lambda; 2/23 (8.69%) WBs at asterion [1/23 (4.34%) at the right asterion and 1/23 (4.34%) at the left asterion of 2 diverse skulls]; 2/23 (8.69%) WBs at sagittal sutures; 1/23 (4.34%) WBs at the left squamous suture; 3/23 (13.04%) WBs at parietomastoid sutures [2/23 (8.69%) at the right parietomastoid sutures and 1/23 (4.34%) at the left parietomastoid suture and 1 pair of them bilaterally located; , ].(Figure is included in full-text article.)(Table is included in full-text article.)(Table is included in full-text article.) CONCLUSIONS: : There was a significant difference in rates between coexistence of WBs with metopism (11/12, 91.66%) and coexistence of metopism with WBs (11/95, 11.58%). The factors leading to metopism may also lead to WBs, whereas that the factors leading to WBs may not lead to metopism.

The Incidence and Topographic Distribution of Sutures Including Wormian Bones in Human Skulls.

OBJECTIVE: The Wormian Bones are accessory bones located within the cranial sutures and fontanelles. The present article examines the incidence of Wormian Bones and compares the number and topographic distribution between the sutures including Wormian Bones in skulls of West Anatolian Population. METHODS: One hundred fifty crania were examined. The parameters evaluated in the present study were as follows: the rate of skulls including Wormian Bones; the topographic distribution and frequencies of the sutures including Wormian Bones; the number of these sutures for each skull; the name and number of sutures that were bilaterally and symmetrically located on the right and left side of skull (paired sutures) and which coincidentally had Wormian Bones for each skull; the differences of frequencies between the paired sutures including Wormian Bones. RESULTS: The rate of skulls including Wormian Bones was determined as 59.3%. The maximum and minimum numbers of sutures, including Wormian Bones, were 6 in 1 skull and 1 in each of 30 skulls, respectively. The maximum and minimum rates of sutures that had Wormian Bones were found in left lambdoid 40.7% and right occipitomastoid 1.3% sutures, respectively. There was only a significant difference between the rate of right and left squamous sutures (P = 0.04). Forty-five skulls were including 55 pairs of bilaterally and symmetrically located sutures that coincidentally had Wormian Bones in each pair. Each of 35 skulls had 1 pair of sutures including Wormian Bones and each of 10 skulls had 2 pairs. CONCLUSIONS: In the present study, the rate of Wormian Bones was determined as 59.3% in West Anatolian Population. This incidence rate is considerably lower than the other reports, and it may be as a result of racial variations. These divergent bones were more frequently found in left lambdoid sutures (40.7%) and less frequently in right occipitomastoid sutures (1.3%). This study may guide the investigators dealing with the neurosurgery, orthopedy, radiology, anatomy, and anthropology in their practice.

Morphometrical aspect on angular branch of facial artery.

Anatomic variability and anastomosis of the angular artery of the facial artery with the other arteries are important for both anatomists and surgeons. In particular, the angular artery is a significant landmark in dacryocystorhinostomy. Because of variations on anatomy of the angular artery, there are limited numbers of anatomic studies on the flaps of facial region. Hence, the aim of the cadaveric study was to evaluate the anatomic features of the angular artery in detail to help surgical procedures.The artery was represented under ×4 loop magnification in 32 sides of 16 formalin-fixed adult cadavers. The angular artery's position, diameter, and branch patterns relevant to the nose arterial supply were evaluated. The facial artery ended symmetrically in 10 (62.5%) of the cadavers. The facial artery was terminated as angular artery in all of the cases. The types of the angular artery were as follows: classical angular type in 8 cases (25.0%), nasal type in 15 cases (46.9%), alar type in 4 cases (12.5%), and labial type in 5 cases (15.6%) on the facial halves. We studied the topographic anatomic features of the angular artery for increasing reliability of the flaps on the region. The angular arterial anatomic details are critical and essential for surgical cosmetic and functional results.

The localization and morphology of pterion in adult West Anatolian skulls.

The pterion is an important skull landmark because it is located where the frontal, the great wing of sphenoid, parietal, and squamous parts of the temporal bone junction. The objectives of this study were to determine the localization and the shape of pterion on skulls and to find out the distances between the pterion and some certain anatomic landmarks on neighboring structures. The study was performed on the skulls of 128 (256 sides) adult West Anatolian people. All of the morphometric measurements of the distances between the pterion and the anatomic landmarks were performed using a Vernier caliper with an accuracy of 0.1 mm. The pterion was classified into 4 types: the sphenoparietal, frontotemporal, stellate, or epipteric types. The incidences of types of pterion in the skulls were also found as the sphenoparietal type (85.2%), the epipteric type (8.2%), the stellate type (5.5%), and the frontotemporal type (1.1%). The mean (SD) distances from the center of the pterion to the zygomatic arch were measured as 40.02 (4.06) mm and 39.88 (4.01) mm; to the frontozygomatic suture, 31.80 (4.51) mm and 31.44 (4.73) mm; to the zygomatic angle, 41.54 (4.95) mm and 41.35 (5.14) mm; to the mastoid process, 82.48 (5.45) mm and 81.81 (5.50) mm; and to the external acoustic meatus, 53.29 (4.55) mm and 56.22 (4.60) mm, on the right and left sides, respectively. The mean (SD) distances between the foremost point of pterion and the anterior edge of the lateral wall of the orbit were 31.02 (5.78) mm and 32.31 (5.79) mm on the right and left sides, respectively. The localization and the shape of pterion are of importance because it is an anatomic landmark and should be of use in surgical approaches and interventions via the pterion.

The volume of experimental design cerebellum: stereological microanatomic study.

Cerebellum is responsible to higher cognitive functions and delicate motor activity. Because of its significance, cerebellum may play a major role in cognitive, behavioral, and psychiatric diseases. Therefore, the investigations on cerebellum may be contributed to the future researches so as to solve reasons of the diseases. The rabbit brain relatively larger than the rat and mouse brain and the individual evaluation of its subdivisions are rather easy. There are no data on cerebellar volume of rabbits in literature. Thus, the study presents microscopic volume calculation of rabbits' cerebellum using the stereological method. The mean (SD) calculated volume of the cerebellum in the rabbit brain was found to be 0.69 (0.03) cm3. The individual microscopic volume estimation of an animal subject can be achieved by Cavalier method. Researchers believed that the findings and the applied method in this study may be useful for the scientists.