Angle Evaluation of Possible Routes that Can Be Used to Reach the Foramen Ovale in the Anterior Approach / Evaluación Angular de Posibles Rutas que se Pueden Utilizar para Alcanzar el Foramen Oval en el Abordaje Anterior

SUMMARY: For the treatment of trigeminal neuralgia, the foramen ovale is reached by entering the cheek with a needle. Thermocoagulation is performed with balloon compression, administration of alcohol or radiofrequency. Apart from the classical method, it is theoretically possible to reach the foramen ovale through the mouth with the anterior approach. In our study, it was aimed to examine horizontally and vertically the angular values that must be given to the needle to reach the foramen ovale in the anterior approach. Three landmark points were determined on both right and left sides of 25 dry skulls. A rod was inserted starting from these landmark points and passing through the center of the foramen ovale. The vertical and horizontal angular values of this bar were measured. For each foramen ovale, 3 vertical angles, 3 horizontal angles and 4 distance measurements were made. There was a significant difference between the right and left sides in terms of horizontal angular values. Average values of horizontal angles (in degrees); on the right, 7.29 for H1, 12.15 for H2, 32.29 for H3; 1.26 for H1, 9.46 for H2, and 30.56 for H3 on the left side (p<0.005). The angle value was measured as 0 or negative value in 5 (20 %) of the H1 angle measurements made on the right side and 14 (56 %) on the left side. The H2 angle value was found to be smaller than the H1 angle in the skull 2 (8 %) on the right and 3 (12 %) on the left. There was no difference between the right and left sides in terms of vertical angular values. A significant difference was found between the right and left sides in the D1, D2, D4 distances (p<0.005). Six important anatomical features affecting angular values were encountered.

Para el tratamiento de la neuralgia del trigémino, se alcanza el foramen oval introduciendo una aguja en la mejilla. La termocoagulación se realiza con compresión con balón, administración de alcohol o radiofrecuencia. Aparte del método clásico, en teoría es posible alcanzar el foramen oval a través de la cavidad oral mediante el abordaje anterior. En nuestro estudio se tuvo como objetivo examinar horizontal y verticalmente los valores angulares que se deben dar a la aguja para alcanzar el foramen oval en el abordaje anterior. Se determinaron tres puntos de referencia en los lados derecho e izquierdo de 25 cráneos secos. Se insertó una varilla comenzando desde estos puntos de referencia y pasando por el centro del foramen oval. Se midieron los valores angulares verticales y horizontales de esta barra. Para cada foramen oval se realizaron mediciones de 3 ángulos verticales, 3 ángulos horizontales y 4 distancias. Hubo una diferencia significativa entre los lados derecho e izquierdo en términos de valores angulares horizontales. Valores medios de ángulos horizontales (en grados); a la derecha, 7,29 para H1, 12,15 para H2, 32,29 para H3; 1,26 para H1, 9,46 para H2 y 30,56 para H3 en el lado izquierdo (p<0,005). El valor del ángulo se midió como 0 o valor negativo en 5 (20 %) de las mediciones del ángulo H1 realizadas en el lado derecho y 14 (56 %) en el lado izquierdo. Se encontró que el valor del ángulo H2 era menor que el ángulo H1 en el cráneo 2 (8 %) a la derecha y 3 (12 %) a la izquierda. No hubo diferencia entre los lados derecho e izquierdo en términos de valores angulares verticales. Se encontró diferencia significativa entre el lado derecho e izquierdo en las distancias D1, D2, D4 (p<0,005). Se encontraron seis características anatómicas importantes que afectan los valores angulares.

Prevalence of the Accessory Cardiac Bronchus on Multidetector Computed Tomography: Evaluation and Proposed Classification.

PURPOSE: Accessory cardiac bronchus (ACB) is a very rare congenital anomaly and may cause some clinical complications, such as recurrent episodes of both infection and hemoptysis. The purpose of this study was to assess the multidetector computed tomography (MDCT) characteristics of ACB and to classify this anomaly according to the MDCT aspects. MATERIALS AND METHODS: The routine thoracic CT scans from 5790 patients were evaluated retrospectively. The prevalence, location, length, diameter, division angle, distance from the carina, and the type of ACB were evaluated. RESULTS: A total of 12 ACBs were identified, with a prevalence of 0.2%. All ACBs originated from the intermediate bronchus. The median largest diameter of the ACBs was 7.75 mm (range: 5.8 to 10.30 mm), the median length was 12.1 mm (range: 8.6 to 35 mm), the median division angle was 61 degrees (range: 42 to 93 degrees), and the median distance from the carina was 16.95 mm (range: 5.7 to 22.20 mm). Six cases (50%) had a blind extremity (type 1: diverticulum or stump type), 3 cases (25%) had a mutiloculated cystic change at the end (type 2: cystic type), and 3 cases (25%) had a ventilated lobulus demarcated by an anomalous fissure (type 3: ventilated type). CONCLUSIONS: ACBs can be classified into 3 types according to their MDCT features. Recognition of ACB is important, as it is associated with clinical complications and is also salient in trauma cases.

Increased adult neurogenesis in the subventricular zone in a rat model of sepsis.

Neurogenesis occurs in the adult brain throughout the lives of all mammals. The dentate gyrus (DG) of the hippocampus and the subventricular zone (SVZ) of the lateral ventricles have been established as the primary sites of adult neurogenesis, and recent studies have shown that inflammation has a modulating effect on adult neurogenesis. However, only limited studies have investigated how neurogenesis is affected during sepsis and sepsis-associated encephalopathy. Therefore, we investigated adult neurogenesis in the cecal ligation and puncture (CLP) model of sepsis using a cell proliferation marker, 5-bromo-2'-deoxyuridine (BrdU). Twenty-four rats were placed into the following three groups: an un-operated control group, a sham-operated group that underwent exactly the same procedures except for CLP, and a CLP group that survived surgical procedures and developed signs of sepsis. Rats were monitored for twenty-four hours before they were euthanized and their brains were harvested. Significantly higher numbers of BrdU-immunoreactive cells were observed in the SVZ of the lateral ventricles in the CLP group as compared with both control groups, while no significant difference was found in the number of DG granule cells between the three groups. The majority of BrdU-positive cells in the SVZ co-expressed the neuronal marker doublecortin but not the astrocytic marker glial fibrillary acidic protein. Taken together, our results suggest that sepsis induced by CLP in rats increases region-specific cellular regeneration, in a possible attempt to compensate for the devastating effect of sepsis and sepsis-associated encephalopathy on the brain.

Sepsis induces apoptotic cell death in different regions of the brain in a rat model of sepsis.

Sepsis occurs in 14-37 percent of patients admitted to intensive care units and sepsis associated encephalopathy (SAE) is its severe complication. In an attempt to provide insight into the question how sepsis and SAE contributes cerebral dysfunction, apoptotic cell death was investigated in hippocampal formation, centers of adult neurogenesis and main autonomic centers which are known to regulate heart rate, respiration and other visceral activities, in cecal ligation and puncture (CLP) rat model of sepsis. Vital parameters and electrophysiological changes were monitored for the confirmation of sepsis and SAE, respectively. Apoptotic cell death was evaluated by TUNEL staining, Caspase-3 immunohistochemistry and transmission electron microscope (TEM). Significantly higher number of TUNEL positive apoptotic cells in the median preoptic nucleus, subventricular zone, dentate gyrus and CA1 and CA3 regions of the hippocampal formation were observed in CLP group and Caspase-3 immunohistochemistry and TEM findings were in line with these results, suggesting that the apoptotic cell death would bare a major role in the pathogenesis of the SAE.

Alterations in the brain electrical activity in a rat model of sepsis-associated encephalopathy.

Sepsis and septic shock are the commonest causes of death in the intensive care units. Although recent research have improved our understanding of the progress and pathophysiology of sepsis and septic shock, underlying mechanisms in sepsis-associated encephalopathy is still poorly understood. The incidence of sepsis-associated encephalopathy has been reported to vary from 8% to 70% of septic patients. We aimed at investigating the brain's electrical activity using somatosensory-evoked potentials and electrocorticographical recordings in cecal ligation and puncture rat model of sepsis. Significant decrease in mean arterial pressure, increase in heart rate, deteriorated neurological reflexes together with positive blood cultures results, thrombocytopenia and increased blood lactate levels suggesting the successful induction of sepsis in the present study. Elongated latencies and increased amplitudes were observed in somatosensory recordings of septic group, while electrocorticograms revealed slight decrease in median and spectral edge frequencies amplitudes and significantly increased delta activities in 50% of the septic rats. These results would suggest that the studies based on the investigation of the sepsis-associated encephalopathy in animal models needs to be combined with the electrophysiological confirmations of the brain dysfunction following the induction of sepsis.