Statin intensity and postoperative mortality following open repair of intact abdominal aortic aneurysm.

BACKGROUND: There is a lack of evidence for the association between intensive statin therapy and outcomes following vascular surgery. The aim of this study was to evaluate the association between perioperative statin intensity and in-hospital mortality following open abdominal aortic aneurysm (AAA) repair. METHODS: Patients undergoing open AAA repair between 2009 and 2015 were identified from the Premier Healthcare Database. Statin use was classified into low, moderate and high intensity, based on American College of Cardiology/American Heart Association guidelines. Supratherapeutic intensity was defined as doses higher than the recommended guidelines. Multivariable logistic regression analyses were undertaken to assess the association between statin intensity and postoperative major adverse events and in-hospital mortality. RESULTS: Of 6497 patients undergoing open AAA repair, 3217 (49·5 per cent) received perioperative statin. Statin users were more likely to present with three or more co-morbidities than non-users (26·5 versus 21·8 per cent; P < 0·001). Unadjusted postoperative mortality was significantly lower in statin users (2·6 versus 6·3 per cent; P < 0·001); however, there was no difference in the risk of developing major adverse events. Multivariable analysis showed that statin use was associated with lower odds of death (odds ratio 0·41, 95 per cent c.i. 0·31 to 0·54). Moderate, high and supratherapeutic statin intensities were not associated with lower odds of death or major adverse events compared with low-intensity statin therapy. CONCLUSION: Statin use is associated with lower odds of death in hospital following open AAA repair. High-intensity statins were not associated with lower morbidity or mortality.

Outcomes of Endovascular Aortic Aneurysm Repair in Kidney Transplant Recipients: Results From a National Quality Initiative.

Contrast-induced nephropathy after endovascular aortic aneurysm repair (EVAR) in kidney transplant recipients (KTRs) can have devastating consequences. The Vascular Quality Initiative (VQI) database was queried to select all KTRs who underwent EVAR between January 2003 and December 2014. Our primary outcome was renal dysfunction, defined as acute kidney injury (AKI; elevation of serum creatinine >0.5 mg/dL from baseline) or new postoperative hemodialysis requirement. Within the EVAR VQI dataset, 40 patients were KTRs (40 of 17 213, or 0.2%). Renal dysfunction occurred in five of 40 patients in the KTR group in comparison to 779 of 17 173 patients in the nontransplanted group (12.5% versus 4.5%, p < 0.01). Emergent EVAR was required in 2 (5%) patients, one of whom required dialysis after surgery and subsequently died. One-year survival after EVAR was similar in the two groups (92.9% versus 93.1%, p = 0.73). KTRs who developed renal dysfunction had significantly lower preoperative estimated glomerular filtration rates (eGFRs) (29.5 versus 54.7, p = 0.007) and a significantly higher iodine:eGFR ratio (0.78 versus 0.39, p = 0.02) despite receiving a similar volume of contrast (70.0 versus 68.8, p = 0.97). Renal dysfunction is 3 times more frequent in KTRs treated with EVAR, though overall survival did not differ between the groups. Decreased preoperative eGFR and a higher iodine:eGFR ratio are associated with postoperative renal dysfunction.

Foetal development of the pancreas.

In the present study, we aimed to gather morphometric data on the localisation and development of the pancreas during the foetal period. The study was carried out on 222 human foetuses aged 9-40 weeks of gestation with no external pathology or anomaly. The abdominal wall was dissected after general external measurements of the foetuses were carried out. Data on the localisation of the pancreas in the abdominal cavity and its localisation relative to the median plane, xiphoid process, and umbilicus were acquired and various morphometric parameters including the length of the pancreas and heights of the head and body of the pancreas were measured. It was found that, in the foetal period, the foetal pancreas was primarily accumulated on the transverse plane passing through the umbilicus, and on the other quadrants. Means and standard deviations of all morphometric parameters were calculated for each gestational week, month, and trimester. There were significant relations between the parameters and gestational age (p < 0.001). There were no differences in any of the parameters between sexes (p > 0.05). In conclusion, morphometric and location data on foetal pancreases acquired in the present study will contribute to other studies carried out in obstetrics, perinatology, forensic medicine, and foetal pathology departments, aimed at identifying anomalies, pathologies, and variations of the pancreas and treatment of such cases.

Bilateral renal vein thrombosis and subsequent acute renal failure due to IVC filter migration and thrombosis.

A 53-year-old man developed a deep venous thrombus (DVT) and pulmonary embolism (PE) shortly after an open Roux-en-Y gastric bypass was performed. He later suffered a life-threatening gastrointestinal bleed while on anticoagulation for the DVT. Thus, anticoagulation was held and an inferior vena cava (IVC) filter (G2, Bard Inc., Tempe, AZ, USA) was placed for PE prophylaxis. About 10 days after filter placement, he presented with severe low back pain and syncope. He also presented with hypotension and anuria unresponsive to intravenous fluids. A STAT non-contrast CT scan of the abdomen revealed that his IVC filter had migrated from an infrarenal to a suprarenal position. Given the high clinical suspicion for renal vein thrombosis, an attempt at IVC filter retrieval was made. The filter could not be retrieved because it was embedded in a large IVC thrombus that extended from the hepatic veins down to the common iliac veins. The patient received nearly 4 days of tPA that was administered at the site of the thrombus with a long thrombolytic catheter (UNIFUSE, Angiodynamics, Queensbury, NY, USA). While his creatinine peaked at 7.6 on hospital Day 4, he eventually began to produce urine and his creatinine had declined to his baseline of 1.0 on follow-up 1 month later. About 18 months after admission, his creatinine had further declined to 0.8. We report the first published case of acute renal failure due to bilateral renal vein thrombosis in the setting of IVC filter migration and thrombosis. This report highlights an important, but rare complication of IVC filter placement as well as the non-operative management of acute bilateral renal vein thrombosis.

Uncoupled responses of Smad4-deficient cancer cells to TNFalpha result in secretion of monomeric laminin-gamma2.

BACKGROUND: Functional loss of the tumor suppressor Smad4 is involved in pancreatic and colorectal carcinogenesis and has been associated with the acquisition of invasiveness. We have previously demonstrated that the heterotrimeric basement membrane protein laminin-332 is a Smad4 target. Namely, Smad4 functions as a positive transcriptional regulator of all three genes encoding laminin-332; its loss is thus implicated in the reduced or discontinuous deposition of the heterotrimeric basement membrane molecule as evident in carcinomas. Uncoupled expression of laminin genes, on the other hand, namely overexpression of the laminin-gamma2 chain is an impressive marker at invasive edges of carcinomas where tumor cells are maximally exposed to signals from stromal cell types like macrophages. As Smad4 is characterized as an integrator of multiple extracellular stimuli in a strongly contextual manner, we asked if loss of Smad4 may also be involved in uncoupled expression of laminin genes in response to altered environmental stimuli. Here, we address Smad4 dependent effects of the prominent inflammatory cytokine TNFalpha on tumor cells. RESULTS: Smad4-reconstituted colon carcinoma cells like adenoma cells respond to TNFalpha with an increased expression of all three chains encoding laminin-332; coincubation with TGFbeta and TNFalpha leads to synergistic induction and to the secretion of large amounts of the heterotrimer. In contrast, in Smad4-deficient cells TNFalpha can induce expression of the gamma2 and beta3 but not the alpha3 chain. Surprisingly, this uncoupled induction of laminin-332 chains in Smad4-negative cells rather than causing intracellular accumulation is followed by the release of gamma2 into the medium, either in a monomeric form or in complexes with as yet unknown proteins. Soluble gamma2 is associated with increased cell migration. CONCLUSIONS: Loss of Smad4 may lead to uncoupled induction of laminin-gamma2 in response to TNFalpha and may therefore represent one of the mechanisms which underlie accumulation of laminin-gamma2 at the invasive margin of a tumor. The finding, that gamma2 is secreted from tumor cells in significant amounts and is associated with increased cell migration may pave the way for further investigation to better understand its functional relevance for tumor progression.

Development of the fetal duodenum: a postmortem study.

OBJECTIVE: To gather detailed morphometric data to be able to assess fetal development of the duodenum and its morphology. MATERIAL AND METHOD: The present study was carried out on 222 human fetuses (114 males, 108 females) aged 9-40 weeks of gestation with no external pathology or anomaly. Fetuses were grouped based on gestational weeks, months and trimesters. Once general external measurements of the fetuses were carried out, the abdominal wall was dissected. The relationships between the duodenum and surrounding structures and its localization were determined. Morphometric data on height, width, length and diameters were gathered. FINDINGS: Means and standard deviations of all parameters were calculated for each gestational week, month and trimester. There were significant relations between measured parameters and gestational age (p < 0.001). There were no sex differences in parameters (p > 0.05). All data were compared with previous studies and discussed. CONCLUSION: Data obtained in this study will contribute to other studies carried out in obstetrics, perinatology, forensic medicine and fetal pathology departments, aimed at identifying anomalies, pathologies and variations of the duodenum and treatment of such cases.

Anatomical development of urinary bladder during the fetal period.

The aim of this study was to determine the development, location, and size of the urinary bladder during the fetal period. The study was performed on 149 human fetuses between 9 and 40 weeks of gestation. The location of the urinary bladder with respect to transverse plane between the highest point of pubic symphysis and the sacral promontory and median sagittal plane was first determined. The dimensions and the angle of the urinary bladder were measured, and bladder shapes were determined. In addition, the edges of the vesical trigone were measured. There was no significant difference between sexes for any of the parameters (P > 0.05). A significant correlation was observed between all parameters and gestational age (P < 0.001). The urinary bladder was located above the transverse plane in most of the cases (83%) and in the median sagittal plane in every case. It was determined that the angle of bladder did not change and the mean value of the angle was 151 degrees during the fetal period. Bladder was categorized into four different shapes (ellipsoid, round, cuboid, and triangular), and the most common shape found during the fetal period was cuboid. The vesical trigone was an isosceles triangle during the fetal period. The new data provided by this study will enable evaluation of the development of the fetal urinary bladder, and should be useful in several fields such as anatomy, fetopathology, medical imaging, obstetrics, and pediatric urology.

Anatomical development of the fetal uterus.

OBJECTIVE: The objective of this study was to gather data on the morphology of the uterus during its development, to provide detailed information regarding the neighboring structures and its variations using anatomical dissections. STUDY DESIGN: Eighty uteri acquired from female fetuses aged 10-40 weeks of gestation were used in this study. Firstly, the relationship between the fetal uterus and the linea terminalis and the position of the uterus within the pelvic cavity was noted. Then the distance between the fundus of the uterus to the promontory and pubic symphysis were measured. Fetal uteri were classified according to their physical appearances. Finally the lengths of the corpus and cervix in three planes and the anteflexion angle were measured. RESULTS: During the fetal period, the fundus of the uterus was above the linea terminalis in 94% and below it in 6% of the cases. The distance between the fundus of the uterus and the promontory significantly correlated with the distance between the fundus of the uterus and the pubic symphysis (p<0.001). This was true for the correlation between the gestational age and the orthogonal lengths of the uterine corpus and cervix (p<0.001). As the gestational age advanced, the anteflexion angle was noted to reduce from 177 degrees to 120 degrees . The shape of the uterus was either cylindrical, pear-shaped, heart-shaped or hourglass-shaped during the fetal period. CONDENSATION: We believe that the data obtained through dissections of the human fetuses in this study will help identifying uterine developmental variations, anomalies and pathologies and will contribute to the studies carried out in obstetrics, perinatology, forensic medicine and fetal pathology departments.

Development of the vermiform appendix during the fetal period.

This study aimed to determine the location and development of the vermiform appendix (VA) in terms of morphometry. It was carried out on 80 human fetuses that exhibited neither external pathology nor anomaly and whose gestational ages were between 10 and 40 weeks. The location of the VA and cecum was established. Total VA diameter, lumen diameter, wall thickness, serosa, muscularis and mucosa thickness were measured on microscope slides. The VA was almost always observed in the subcecal region during the fetal period. The length of the VA and the attachment length of the meso-appendix to the VA increased with the gestational age. Lymphocyte aggregation was first seen at the 17th week of the fetal period. Positive and meaningful correlation was found between gestational age and morphometric parameters of the VA. A significant difference was found between the genders in the thickness of mucosa, which was larger in girls (p<0.05). When the proximal, median and distal parts were compared, the thickness of serosa between the proximal and distal parts was also significantly different (p<0.05). The present study has revealed that the VA matures in the second trimester during the fetal period. Furthermore, the morphologic development of the VA is almost uniform from the proximal to distal part.

Splenodiaphragmatic interposition of the descending colon.

We present a variation named splenodiaphragmatic or retrosplenic interposition of the colon in three patients aged 6, 70, and 71 years who suffered from different symptoms. The cases were found in 1,000 thoracoabdominal CT scans examined at the radiology clinic between 1999 and 2001. The upper part of descending colon was seen to be between the spleen and the left kidney on abdominal CT scans with contrast enema in the patient aged 71 years. In a 6 year-old child, part of the left colic flexure in the intestinal gas patterns was located between the left kidney and spleen, extending up to the diaphragm in the left hypochondrium on radiological examinations. The left colic flexure and the beginning of the descending colon were imaged on CT behind the spleen at the level of the 11th thoracic vertebra in the third patient aged 70 years. Hepatodiaphragmatic interposition of the colon has been reported previously in many patients; however, no detailed reports are available dealing with the interposition of the descending colon between the diaphragm and spleen. Three cases with retrosplenic colon variation were investigated in detail in the present study. The significance of retrosplenic colon is discussed. It is concluded that the identification of this anatomical variation could avoid unnecessary colon perforation during percutaneous nephrostomy, splenostomy, biopsy, or splenectomy.

Morphology of umbilical vessels in human fetuses: a quantitative light microscope study.

OBJECTIVE: To investigate the development of the intra-abdominal part of the umbilical vessels in human fetuses by light microscopy. MATERIALS AND METHODS: The location of the umbilicus and umbilical vessels in the abdominal cavity of 90 human fetuses of gestational ages 10-40 weeks was determined. The external vessel diameter, lumen diameter, wall thickness, tunica adventitia thickness, tunica media thickness and the number of vasa vasorum were recorded from cross-sectlons of the intra-abdominal part of the umbilical vessels. 1985). 1985). RESULTS: Umbilical artery agenesis was observed on the left side in two cases and on the right in one case. There was a positive correlation between gestational age and umbilical vessel measurements. There were differences between the vessel and lumen diameters, tunica media thicknesses of the vessels of the second and third trimesters, and the full-term period. There were also predictable differences between the vessel and lumen diameters, tunica media and tunica adventitia thicknesses of the umbilical vein and umbilical arteries. CONCLUSION: Detailed information on quantitative parameters of umbilical vessels at each gestational age may prove helpful in determining pathologies of umbilical vessels and illuminating certain syndromes.

An investigation of the conus medullaris termination level during the period of fetal development to adulthood.

The spinal cord fills the length of the vertebral canal at the early period of intrauterine term. It is reported to extend to the level of the third lumbar vertebra at birth, because the vertebral column is growing more rapidly in the longitudinal direction than the spinal cord. The present investigation aimed to determine the changes in the termination level of conus medullaris (TLCM) from fetus to adulthood in a total of 285 individuals who had no defects in the central or peripheral nervous system, and were obtained from our Faculties of Medicine and Konya Maternity Hospital between 1992-1995. The age distribution was as follows: 36 fetuses, 20 prematures and 50 neonates, 51 children aged 1 to 7 years and 128 adults aged 15 to 68 years. In this study, for fetuses, prematures, neonates and children the TLCM was determined using ultrasonography. In addition, microdissection was used in fetuses to confirm the results obtained from the above technique. Also, magnetic resonance imaging was used in adults. During fetal life the end of the conus altered its levels from S5 to L3 vertebrae. The tip of the conus medullaris of the prematures and neonates ranged from L1 to L3 vertebrae. The tip of the conus medullaris in the children lay between the Th12 and L3 vertebrae, and in the adults it was between the Th12 and L2 vertebrae. There were slight differences between the prematures and neonates in terms of the TLCM. We concluded that there are differences in the TLCM between the age groups and therefore, especially in prematures and infants the determination of the tip of conus medullaris might be important for preventing postoperative neurological complications.

Effect of diclofenac sodium administration during pregnancy in the postnatal period.

OBJECTIVE: The present study aimed to investigate the possible postnatal effects on the liver, kidney and testicular tissues of the offspring of rats given diclofenac sodium (DS) during pregnancy. METHODS: At the beginning of the experiment, 80 rats (20 males and 60 females) were raised together for mating purposes. At the end, 50 pregnant rats were obtained and used as the experimental subjects. All pregnant rats were divided into 2 groups, each with 25 rats. The rats of the control group received physiological serum, 1 cm3/kg live weight per day, and the rats of the treatment group were injected with DS, 1 mg/kg live weight per day from the 5th to the 20th day of pregnancy. Four weeks after birth, tissue samples were obtained under anesthesia by perfusion fixation from a total of 40 offspring, 20 (10 males, 10 females) from the control group and 20 (10 males 10 females) from the DS group. Paraffin sections were dyed with hematoxylin eosin and examined under light microscopy. RESULTS: The gestation period was significantly prolonged with DS-treated rats (p < 0.001). A moderate significant enlargement in the periportal area (p < 0.05), sinusoidal dilatation (p < 0.001), bile duct proliferation (p < 0.001), pyknosis in the nucleus of hepatocytes, and vacuolar degeneration in parenchymal cells (p < 0.001) were observed in DS-treated rats. Morphological changes in the liver were found to be similar both in female and male rats. Under light microscopy a similar morphological structure was observed in the kidney and testicular tissues of both the DS-treated and control rats. CONCLUSION: Significant morphological changes were observed in the livers of the offspring whose parents had been treated with DS. No significant differences were observed in liver morphology between the female and male offspring. There were no significant effects of DS on the morphology of the kidney and testis in all offspring.

Growing of caecum and vermiform appendix during the fetal period.

OBJECTIVE: The aim of this study is to investigate the growing of the caecum and the vermiform appendix during the fetal period in human fetuses and the relation between growing and shape of the caecum and the localization of the vermiform appendix. METHODS: 40 male and 40 female externally normal-looking fetuses were studied between 10 and 40 weeks of gestation and were subdivided into fetuses of the 1st, 2nd, and 3rd trimesters and full-term fetuses. The parameters of interest included covering of the caecum with peritoneum, shape of the caecum (long tube, symmetric saccule, asymmetric saccule, extremely large right side--atypical), axial length and width of the caecum localization of the vermiform appendix, length of vermiform appendix and length of the meso-appendix. RESULTS: There was a difference in covering of the caecum with peritoneum between males and females; the caecum was predominantly tube shaped during the fetal period, with the asymmetric saccule towards the end of the fetal period; the localization of the vermiform appendix was subcaecal (39%) during the fetal period and postileal (34%) in female fetuses and subcaecal (48%) in male fetuses--the localization of the vermiform appendix changed according to the caecum shape during the fetal period; we found significant differences in the measurements of vermiform appendix, meso-appendix, and caecum among 1st-, 2nd-, and 3rd-trimester fetuses and full-term fetuses. CONCLUSIONS: There was an increase in the measurements for vermiform appendix, meso-appendix, and caecum with increasing gestational age; the localization of the vermiform appendix depended on the shape of the caecum, was different from that of adults and different between sexes, and there was also a significant difference in covering of the caecum with peritoneum between both sexes.

Estimating the testis volume during the fetal period using the stereological method.

The purpose of the present study is to assess the development of seminiferous tubule volume, stromal volume and total testis volume in the human fetal testis during the fetal period using the stereological method. In this study, we examined 90 testes of 45 human fetuses with no congenital anomalies and pathologies. They were aged between 12 and 40 weeks and localized between the scrotum and the abdomen. Total testis volume, seminiferous tubule volume, and stromal volume were estimated using Cavalier Principles. The weight and density of the testes were calculated as well. During the fetal period, the testes were firstly found on the right in the 27th week and on the left in the 32nd week in the scrotum. At the end of the third trimester and full term, the migration of the testes into scrotum was completed (98%). When the second trimester, third trimester and full term fetuses were compared, the differences between testis volumes were significant (p<0.001). The density of the testes between the groups was not significant (p>0.05). Testis parameters during the fetal period were not significantly (p>0.05) different between the right and left testes localization. The correlation between the fetal testis parameters was significant (p<0.001). Towards the end of the fetal period, the rate of seminiferous tubule volume to stromal volume changed in the favor of seminiferous tubule volume. It was observed that interstitial tissue became more regular and had a good organized structure with the progress of gestational age. In the third trimester, the lumen in the seminiferous tubules became more regular and clear and the interstitial tissue had a clear appearance.

An investigation of the conus medullaris and filum terminale variations in human fetuses.

The morphologic structure of the conus medullaris and filum terminale was investigated by dissection in 123 human fetuses, obtained from Selçuk University, Faculty of Medicine and Maternity hospital of Konya between 1992-1995. In 78 fetuses, the conus medullaris and filum terminale had a normal morphologic aspect, whereas there was a slight depression or groove formation in the closure region of the caudal neuropore in 45 fetuses. In 15 fetuses, important malformations of the cranium and vertebral column were observed. The morphologic aspects of the conus medullaris in 30 fetuses were abnormal in shape and position, among them 24 fetuses had an abnormal filum terminale (grooved, depressed, thickened or duplicated) whereas it was normal in 6. Deficiency of closure of the caudal neuropore was considered to have a negative effect on the fetal development of the filum terminale.

The relationship between the lumbosacral enlargement and the conus medullaris during the period of fetal development and adulthood.

The spinal cord is situated within the vertebral canal by the third month of intrauterine life. The spinal cord possesses two symmetrical enlargements, which constitute the segments of the plexuses: the cervical enlargement for the brachial plexus and the lumbosacral enlargement for the lumbar and sacral plexus. In our study, we aimed to investigate the relationship between the termination level of the lumbosacral enlargement (TLLE) and that of the conus medullaris (TLCM) during the period of fetal development and adulthood. We used a total of 75 cases: 25 fetuses (male: 16, female: 9) whose crown-rump length ranged between 90-190 mm, 25 premature and full-term neonates (male: 17, female: 8) whose post-menstrual ages ranged between 33-55 weeks, and 25 adults (male: 12, female: 13) aged between 22-72 years. The dissection technique for fetuses, ultrasonography for premature and full-term newborns, and magnetic resonance imaging (MRI) for adults were used to determine lumbosacral enlargement and TLCM. The differences between the TLCM and the termination level of the largest part of the transverse diameter of the lumbosacral enlargement were investigated. The differences between the TLLE and TLCM were found in different ratios from the period of fetal development to adulthood. Therefore, during medical treatment and surgical procedures this should be taken into account to avoid complications.

Morphology of the metopic suture during the fetal period.

Assessment of the position and size of the metopic suture and anterior fontanelle is important in the routine examination during fetal period and in newborn infants. The aim of this study is to clarify the average size and its developmental changes of the anterior fontanelle and metopic suture by morphometry. Fifty-one cases were examined over a developmental period ranging from fetus of 14 weeks gestation to full term neonate. The width, and length of heads as well as head circumference of all fetuses were measured. The metopic suture and anterior fontanelle sizes were determined. The nearest distances between the parietal bones to the opposite frontal bones, and the distances between the nasion and lower angle of the anterior fontanelle, bregma and upper angle of the anterior fontanelle were measured. The averages of longitudinal and transverse diameters and areas of anterior fontanelle were calculated. Significant correlation was found between all the parameters and gestational ages, and between the sizes of the metopic suture and of skulls. There was no difference between male and female in any of the parameters. In our study, closed metopic suture was not observed. The anterior fontanelle is easy to palpate, and its enlargement might occasionally be helpful in the clinical examination of the newborn infants. The presence of a wide metopic suture may indicate the possibility of additional defects and anomaly in the newborn.

The growth of the upper and lower extremities of Turkish fetuses during the fetal period.

Prenatal analysis of the fetal structures gives us information about fetal growth and gestational age. The aim of this study was to investigate the morphologic structure of the upper and lower extremities of Turkish fetuses during the fetal period, to measure the morphometric values, and to determine the relationship between CRL (crown-rump length) and growth of the foot. In this study, 106 human fetuses (56 males, 50 females) without external anomalies and aged between 10-40 post-menstrual weeks (PMW) were studied. In the upper extremity, the width of shoulder and the length of the arms, forearms and hands were measured. In the lower extremity, the width of the iliac crest, knee condyles, feet, and heels and the length of the thighs, legs and feet were measured. A significant correlation was found between all parameters taken within the fetal period and PMW (p < 0.001). Statistically significant correlations found between foot-growth measurements and fetal parameters indicate that foot length may be a good predictor of age. The measurements of the upper and lower extremities during fetal period are a reliable parameter for use in the assessment of gestational age. These measurements are particularly useful when other parameters do not accurately predict gestational age in some cases such as hydrocephalus, anencephaly, short-limb dysplasia. Our opinion is that the measurements can be useful to assess gestational age in several fields such as anatomy, pathologic anatomy (fetopathology), forensic medicine, medical imaging, obstetrics and pediatrics.

Measurements of anterior fontanelle during the fetal period.

In this study, we aimed to determine the development of the anterior fontanelle during the fetal period by morphometric measurements. One hundred and five (49 males, 56 females) human fetuses were obtained from Isparta Maternity and Pediatric Hospital. The gestational age ranged from 11 to 40 weeks. In all cases, head circumference, head length and biparietal diameter were recorded. The anterior fontanelle, transverse and longitudinal diameters were measured, and the mean anterior fontanelle size and the anterior fontanelle area were calculated. A significant positive correlation was found between the gestational age and all parameters. During the fetal period, the anterior fontanelle area gradually increased with head circumference. There was a sharp increase in third trimester in the area anterior fontanelle. In the present study, there was no significant difference between sexes regarding the all parameters measured or calculated. The mean anterior fontanelle size was larger than that recorded in previous studies for both sexes. As presented in our study, the dimensions of the anterior fontanelle for each gestational age will be useful in the understanding of development and anatomical variation. It may also be useful in the diagnosis of cranial maldevelopment.