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.

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.

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.

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.

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.