Radiographic analysis of the lumbar and sacral region angles in young Turkish adults.

OBJECTIVE: To determine the normal angular ranges of the lateral spinal alignments in the lumbar and sacral regions. METHODS: This cross-sectional study was conducted at the Kilis State Hospital, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey, from February to August 2017, and comprised patients aged 18-27 years who underwent standardised standing lateral lumbar radiography to eliminate hip and low back disorders. All radiographs were obtained from the hospital database as well as the demographic and contact information of each subject. Patients were invited for an interview and physical examination. Standard standing lateral radiographs of the lumbar spine were obtained from those who had no complaint of back pain and/or lower back problems. Sacro-horizontal angle, lumbosacral joint angle and sacral inclination angle were measured on the radiographic images. SPSS 22 was used to analyse data. RESULTS: Of the 150 subjects evaluated, 80(53.33%) were women and 70(46.77) were men. There was no statistically significant difference between women and men regarding lumbar lordosis angle, sacro-horizontal angle and lumbosacral angle (p>0.05). Sacral inclination angle and lower limb length in men were greater than in women (p<0.05). A positive correlation was observed between the lumbar lordosis angle, sacral inclination angle and sacro-horizontal angle values, while a negative correlation with the lumbosacral angle (p<0.05). There was no relationship observed between age, weight, height and body mass index, and sacral inclination, sacro-horizontal and lumbosacral angle values (p>0.05). Lumbar lordosis angle increased depending on the increase of the body mass index (p<0.05). CONCLUSIONS: Values identified can be considered as reference values for young healthy Turkish adults.

Bilateral triple renal arteries.

Knowledge of the variations of the renal artery has grown in importance with increasing numbers of renal transplants, vascular reconstructions and various surgical and radiologic techniques being performed in recent years. We report the presence of bilateral triple renal arteries, discovered on routine dissection of a male cadaver. On the right side, one additional renal artery originated from the abdominal aorta (distributed to superior pole of the kidney) and one other originated from the right common iliac artery (distributed to lower pole of the kidney). On the left side, both additional renal arteries originated from the abdominal aorta. Our observation has been compared with variations described in the literature and their clinical importance has been emphasized.

The angiographic aspects of myocardial bridges in Turkish patients who have undergone coronary angiography.

INTRODUCTION: Little is known of the clinical significance of myocardial bridges, which may be recognised as the narrowing of the systolic coronary artery as seen in an angiography. In this study, our goal was to review the literature information about the anatomic aspects, the clinical manifestations and implications, and the angiographic characteristics. MATERIALS AND METHODS: The angiographic data of 7200 adult patients undergoing coronary angiography were retrospectively analysed for the diagnosis of myocardial bridge. The main angiographic evidence of a myocardial bridge that we required was the narrowing of a systolic coronary artery resulting in at least 50% reduction of lumen diameter in comparison with the diastolic phase. All coronary angiograms were reviewed independently by at least 2 of the authors and the case was included only if there was a consensus that the myocardial bridge resulted in 50% narrowing or more. RESULTS: Myocardial bridge was present in 29 (0.4%) of the 7200 coronary angiographies. The location of the myocardial bridge was in the left anterior descending coronary artery in 28 cases (96.5%), and the left circumflex coronary artery in 1 case (3.4%). Myocardial bridge was most common in the middle segment of the left anterior descending coronary artery (78.5 %). Each of these patients with myocardial bridge was referred for angiography because of symptom of chest pain alone or symptom of chest pain, palpitations and dyspnoea. Of the 29 patients with myocardial bridge, 2 patients without any symptom, demonstrated ischaemia as assessed by Tc- 99m MIBI myocardial perfusion scintigraphy. CONCLUSION: Chest pain was the common reason for angiography in patients with myocardial bridge. The incidence of myocardial bridge may vary according to population. Myocardial bridge is more frequently found in the middle segment of the left anterior descending coronary artery.

Anatomical variations with joint space measurements on CT.

This study has been performed to demonstrate the type and frequency of the anatomical variations of the sacroiliac joint according to age, gender, Body Mass Index and childbirth, and the influence of the anatomical variants to the uniformity and width of the joint space. It was conducted on 400 consecutive patients without sacroiliac complaint who underwent pelvic CT scanning for various reasons. Patients' ages were 15 or above. Anatomical variants that we observed were accessory sacroiliac joint (70 patients, 17.5%), iliosacral complex (38 patients, 9.5%), bipartite iliac bony plate (22 patients, 5.5%), semicircular defects on iliac/ sacral side (19 patients, 4.8%), crescent like iliac bony plate (14 patients, 3.5%) and ossification centers (4 patients, 1.0%). The mean joint space width of the 400 patients was 1.72+/-0.57 mm (from 0.77 mm to 4.39 mm). In adults below 40 years of age, the measured width was 2.49+/-0.66 mm. In older patients, 1.47+/-0.21 mm. Joints which presented anatomical variants (206 articulations) had a non-uniform joint space in 164 (79.6%), whereas uniform joint space were seen in 42 (20.4%) articulations. The joint width were less than 2 mm in 193 (93.7%) articulations and in 13 (6.3%) articulations were greater or equal to 2 mm. This study has demonstrated that anatomical variations and joint space are independently related to age, gender, Body Mass Index and childbirth in patients. We believe that all this information is helpful to interpret and examine the sacroiliac computed tomography images.

Double right coronary artery: review of literature.

Anomalies of the coronary artery are often asymptomatic and uncommon. We report an extremely rare coronary artery anomaly, a double right coronary artery. A 50-year-old male patient was hospitalized with the diagnosis of unstable angina pectoris. Right coronary artery (RCA) injection showed filling of two separately originating RCAs, coursing towards the right atrio-ventricular groove. Then they give a marginal branch and a septal artery, terminated by giving off the posterior descending artery (PDA) in posterior interventricular groove. Coronary anomalies should be recognized to avoid problems during coronary intervention and cardiac surgery.

The effect of age and gender on the anatomic structure of Caucasian healthy eyelids.

OBJECTIVES: To determine the normal values of the eyelid parameters in Caucasians and to describe the effects of age and gender on eyelid and eyebrow anatomy. METHODS: We evaluated the effects of age and gender on eyelid structures in 100 Caucasian volunteers in the Ophthalmology and Anatomy Departments, University of Gaziantep Medical School, Turkey between 2003 and 2004. Forty-five females with mean age of 36 years (5-80 years) and 55 males with mean age of 39 years (3-68 years) participated in the study. We divided subjects into 6 groups according to decades. We measured the palpebral fissure length (PFL), the distance between the pupil center and the upper eyelid (PC-UE) and lower eyelid margin (PC-LE), the eyebrow height (EH), the eye crease height (ECH) and the distance from the reference line to the pupil center (RL-PC), using a reference line through the medial canthus and vertical line through the pupil center of the frontal slides. RESULTS: The measurements of PFL were between 23.5 mm and 29 mm in females, 24.8 mm and 29.1 mm in males and showed a gradual decrease with age. The PC-UE, PC-LE, ECH and RL-PC remained stable throughout life and were identical for both gender. However, EH ranging from 10.7-12 mm in females and 6.5-11 mm in males appeared to have a significant association with gender, which was higher in females than males, but was not effected with age. CONCLUSION: These results demonstrate the importance of providing a normal anatomic relationship that relates to the patient's age and gender.

Frequency in the anomalous origin of the left main coronary artery with angiography in a Turkish population.

We estimated the frequency of anatomic variations in origin of the left coronary artery in a Turkish population by analyzing the angiographic data of 10,042 consecutive adult patients undergoing coronary angiography. Among 10,042 adult patients, 5 (0.04%) patients (4 men and 1 woman, age range 40-74, median 58 years old) had anomalous origin of the left main coronary artery. The left main coronary artery arose from the right coronary sinus of Valsalva in 2 (0.019%) patients (both of them had a retro-aortic course), from above the left coronary sinus of Valsalva in 2 (0.019%) patients, and from above the non-coronary (posterior)-left coronary commisure in 1 (0.009%) patient. Anomalous origin of the left main coronary artery is potentially a serious condition, as it can lead to myocardial infarction and sudden cardiac death under physical exertion. Therefore, greater effort for early detection and surgical repair of this anomaly are warranted. The angiographic recognition of anomalous origin of this vessel may prove useful for physicians dealing with diagnosis and treatment of anomalies of the left main coronary artery.

An unusual localization of an infected urachal sinus.

Failure of obliteration of the urachus in intrauterine life results in anatomically recognizable distinct anomalies. The urachus is located between the umbilicus and apex of the bladder. However, this anatomic feature does not always exist, and this may lead to misdiagnosis of the urachal pathologies. A 5-year-old boy with infected urachal sinus is presented. The urachus showed an unusual anatomic course with its extension from the umbilicus to the right lateral side of the bladder instead of the apex of the organ.

Urethral duplication.

Urethral duplication is a rare congenital anomaly. Although a number of theories have been proposed to describe the embryology of the condition, the actual mechanism of the disorder is still unclear. We report here a case of urethral duplication in a 11-year-old boy complaining of a double stream, and review the current literature on this rare entity.

Evaluation of the fibular incisura of the tibia with magnetic resonance imaging.

Knowledge of the distal tibiofibular syndesmosis should be helpful in determining the normal position of the fibula in the incisural notch. The purpose of this study was to determine the anatomic characteristics of the fibular incisura of the tibia on MR imaging. One hundred fifty lower limbs (43 male, 32 female volunteers) were examined with MRI. The length of the anterior facet was 10.4 mm in males and 8.9 mm in females, and the length of the posterior facet was 10.4 mm in males and 8.9 mm in females. The angle between anterior and posterior facets was 138.6 degrees in males and 139.9 degrees in females. The depth of the fibular incisura of the tibia was 3.6 mm in males and 2.9 mm in females. The vertical distance of tibiofibular overlapping was 7.9 mm in males and 7.0 mm in females. The distance between anterior margin of the tibia and anterior margin of the fibula was 14.3 mm in males and 12.5 mm in females. All of these parameters of men (except the angle between anterior and posterior facets) were significantly higher than the parameters of women (p<.001, p<.001, p<.05, p<.05, p<.01, respectively).

Variants in origin of the left circumflex coronary artery with angiography.

OBJECTIVE: The objective of this study was to assess the anatomic variations in the origin of the left circumflex coronary artery in a Turkish population. METHOD: This study was carried out at the Sani Konukoklu Medical Center, Gaziantep, Turkey, during the period January 1999 through to May 2001. The angiographic data of 10,042 consecutive adult patients who underwent coronary angiography was analyzed for anomalous origin of the left circumflex coronary artery. RESULTS: Among 10,042 adults patients, 27 (0.3%) had anomalous origin of the left circumflex coronary artery. The left circumflex coronary artery arose from the left coronary sinus of valsalva in 15 (55.5%) patients, from the right coronary sinus of valsalva in 7 (25.9%) patients, and from the proximal part of the right coronary artery in 8 (29.6%) patients. CONCLUSION: The anomalous origin of the left circumflex coronary artery may not always be benign. Therefore, recognition of this anomaly is mandatory to prevent the risk of infarction or sudden death. Special surgical considerations must be made when performing valvular replacement in patients with anomalous left circumflex coronary artery.

Hippocampal volume in schizophrenia and its relationship with risperidone treatment: a stereological study.

The purpose of this study was to assess the significance of the hippocampal volume differences and its relation with risperidone treatment in schizophrenia. In schizophrenic patients who were on risperidone treatment (n = 11) and in healthy volunteers (n = 11), volumes of the hippocampi were estimated using magnetic resonance images (MRIs). A detailed systematic series of coronal MRIs of the entire brain (3 mm thickness, T(1)-weighted, TR/TE 400/10 ms) was obtained for each subject. All estimations were done according to Cavalieri's method by a modified point-counting grid placed on surface areas of hippocampal slices. The mean right and left hippocampal volumes in schizophrenics and control subjects were 1059.4 and 1003.2 mm(3), and 1780.1 and 1589.1 mm(3), respectively. The corresponding coefficients of errors were 0.05 and 0.068, and 0.059 and 0.081, respectively. The volumes of left and right hemispheres were not significantly different in both schizophrenic patients and controls (p > 0.05). However, a statistically significant difference (p < 0.05) was found between hippocampal volumes of the schizophrenic patients and controls. In conclusion, the hippocampal volume of the schizophrenic patients is significantly smaller than of the healthy controls. The patients who responded well to risperidone treatment had significantly greater hippocampal volumes than the patients who did not respond properly. Thus, hippocampal volume may be a predictor of the treatment response of schizophrenics to risperidone.

The congenital absence of the radius, scaphoid, trapezium, thumb and hypoplasia of the lunate.

The congenital absence of the right radius, scaphoid, trapezium, thumb and hypoplasia of the lunate are described in a 9-year-old boy. He had full extension of his elbow, while flexion motion was limited to 90 degrees. His hand was radially deviated. The thumb was absent. The index and middle fingers were united and immobile. The ring finger had movement only at the metacarpophalangeal joint, while the little finger had full motion. Complete blood count fell within normal ranges. He had no other malformations or mental retardation. No hereditary family history was found and there was no consanguineous marriage. This case is different from cases mentioned in the literature due to lunate hypoplasia and the anomalies of the index, middle and ring fingers.

The fibular incisura of the tibia with recurrent sprained ankle on magnetic resonance imaging.

OBJECTIVE: The aim of this study was to investigate the fibular incisura of the tibia in type I and II recurrent sprained ankle. METHODS: A total of 18 limbs (9 right, 9 left) were examined for the fibular incisura of the tibia by magnetic resonance imaging at Gunmar Magnetic Resonance Imaging Center between September 2000 to May 2001. This group consisted of 10 males and 8 females and their age ranged between 18-61 years. The control group was made up of 75 participating volunteers without previous history of trauma in the ankle. RESULTS: The measurements of the length of the anterior and posterior facets, depth of the fibular incisura of the tibia and the distance between anterior margin of the tibia and anterior margin of the fibula in the patient group were visibly different from the measurements of the control group. In recurrent sprained ankle, the anterior and posterior tubercles were lengthier, the depth of the fibular incisura of the tibia was deeper and the fibula was more anterior than the control group. The measurements of the angle between anterior and posterior facets and the vertical distance of tibiofibular overlapping in the patient group were slight different from the measurements of the control groups. CONCLUSION: These characteristics, which were observed in the recurrent sprained ankles, may be anatomically predisposed to recurrent ankle sprains.

A magnetic resonance imaging study of the adhesio interthalamica in schizophrenia.

Several recent studies have found a relationship between midline cerebral malformations (cavum septi pellucidum, absence of the adhesio interthalamica) and schizophrenia. In this study, we investigated whether the adhesio interthalamica is more often absent in patients with schizophrenia than healthy cases and whether the absence of the adhesio interthalamica may be related to the volume of the third ventricle. Twenty-six patients (11 male, 15 female) in the schizophrenia group and twenty-nine (11 male, 18 female) cases in the control group were examined by MRI. The adhesio interthalamica was found to be absent more often among patients with schizophrenia compared with control subjects and patients without adhesio interthalamica did not have significantly larger third ventricle volumes. The absence of the adhesio interthalamica may be important in explaining the association between the abnormalities of brain midline structures and schizophrenia.

Frequency in the anomalous origin of the right coronary artery with angiography in a Turkish population.

OBJECTIVE: The estimate frequency of anatomic variations in origin of the right coronary artery in a Turkish population. MATERIAL AND METHOD: The angiographic data of 5253 consecutive adults patients undergoing coronary angiography were analysed retrospectively for the diagnosis of anomalous origin of the right coronary artery. RESULTS: Among 5253 adults patients, five (0.09%) patients had anomalous origin of the right coronary. They had an isolated anomalous origin of the right coronary artery. The right coronary arose from the left coronary sinus of Valsalva (there was separate orificium for the right coronary artery and the left coronary artery) in two (0.03%) patients, from above the left coronary sinus of Valsalva in three (0.05%) patients. In all patients, the anomalous origin of right coronary artery from the left sinus of Valsalva and from above the left coronary sinus of Valsalva coursed between the aorta and the pulmonary artery. CONCLUSION: The anomalous origin of the right coronary artery is a rare congenital cardiac malformation. Most patients remain asymptomatic. However, there are cases of sudden cardiac death described in the literature, indicating a potentially malign course of the disease. The angiographic recognition of this vessel may be useful for physicians dealing with diagnosis and treatment of the anomaly of the right coronary artery.

Congenital absence of the radius, scaphoid, trapezium, thumb and hypoplasia of the lunate.

The congenital absence of the right radius, scaphoid, trapezium, thumb and hypoplasia of the lunate are described in a 9-year-old boy. He had full extension of his elbow, while flexion motion was limited to 90 degrees. His hand was radially deviated. The thumb was absent. The index and middle fingers were united and immobile. The ring finger had movement only at the metacarpophalangeal joint, while the little finger had full motion. Complete blood count fell within normal ranges. He had no other malformations or mental retardation. No hereditary family history was found and there was no consanguineous marriage. This case is different from cases mentioned in the literature due to lunate hypoplasia and the anomalies of the index, middle and ring fingers.

Single coronary artery arising from the left sinus of valsalva.

A single coronary artery is a rare congenital anomaly of the coronary arteries where only one coronary artery arises from the aortic trunk by a single coronary ostium, supplying the entire heart. We report a case of a 57-year-old woman with atypical chest pain, in whom coronary angiography showed a L-I subtype single coronary artery (arising from a single ostium in the left sinus of valsalva) without associated cardiovascular disease. The clinical significance and subtype of the single coronary artery are discussed.

Single coronary artery arising from the right sinus of Valsalva (case report).

A single coronary artery is a rare congenital anomaly of the coronary arteries where only one coronary artery arises from the aortic trunk by a single coronary ostium, supplying the entire heart. We report a case of a 70 years-old man with mitral valvular insufficiency and atherosclerotic right and left circumflex coronary arteries, in whom coronary angiography showed a single coronary artery arising from a single ostium in the right sinus of Valsalva (R-II-B subtype) and transverse trunk coursed between aorta and pulmonary artery. The clinical significance and subtype of the single coronary artery are discussed.