Assessment of the morphology and morphometry of the caudate lobe of the liver using computed tomography.

OBJECTIVE: The caudate lobe differs from the rest of the liver. This study was planned to evaluate the caudate lobe's morphology, morphometry, and vascular structures using computed tomography (CT). PATIENTS AND METHODS: Three hundred eighty-eight cases were evaluated retrospectively in terms of caudate lobe morphology, morphometry, and vascular anatomy from patients undergoing contrast-enhanced abdominal CT for any reason between September 2018 and December 2019. After the application of exclusion criteria, 196 patients were eventually included in the study. RESULTS: One hundred seventeen (59.7%) of the 196 patients were men. The patients' mean age was 57.88 years (ranging from 18 to 82). Morphologically, the caudate lobe was classified as rectangular, piriform, or irregular-shaped, with 117 cases being evaluated as piriform (59.7%), 51 as irregular-shaped (26%), and 28 as rectangular (14.3%). The caudate process was visible in most cases (92.9%). No papillary process was observed in the great majority of patients (87.2%). CONCLUSIONS: Caudate lobe evaluation criteria can be obtained using CT in vivo based on morphological and morphometric values for the caudate lobes yielded by cadaver studies.

Evaluation of the course of the marginal mandibular branch of the facial nerve: a fresh cadaveric study.

The aim of this study was to determine the course of marginal mandibular nerve (MMN) in relation to the inferior border of the mandible from the gonion until its terminal insertion to the depressor anguli oris, relating the position to a palpable anatomical landmark with emphasis on the depth of the nerve in relation to platysma and the deep cervical fascia. Twelve fresh adult cadavers were dissected and the mandibular base was contoured using needles with 5mm gaps, starting from the mandibular angle to the muscular termination point of the nerve bilaterally. The distance between the MMN and the mandibular base and total length of the nerve was measured bilaterally. The highest levels of MMN were measured 6.9mm and 6.5mm above, and the lowest levels were measured 4mm and 3mm below the mandibular base on right and left sides, respectively. The mean (SD) total length of the nerve until the muscular termination point was calculated 33.57 (3.41) mm on the right and 33.51 (4.88) mm on the left side. Previous publications that we had read all fell short of defining the schematic pathway of the nerve, as the described landmarks were of a combination of bone and soft tissue, which are not always clinically reliable. We have overcome this difficulty by standardising the inferior border of the mandible as a point in order to trace the marginal mandibular branch pathway. It originates along the gonion and ends at the second premolar tooth area.

Abnormal type III fusion between lunate and triquetrum: A case report.

INTRODUCTION: The lunotriquetral coalition is the fusion of the lunate and triquetral bones of the wrist and is the most frequent carpal coalition type. It is frequently asymptomatic and discovered as an incidental due to chronic wrist pain, trauma, or fracture. This case aims to present an unusual unilateral lunotriquetral coalition and clinical significance for diagnosis and treatment. PRESENTATION OF CASE: In this case, we presented a 37-year-old male who exhibited with right-sided trauma and wrist pain. He was diagnosed to had a type III complete osseous lunotriquetral coalition on the right side and detected by plain radiography and CT without lytic, destructive, and sclerotic lesions. DISCUSSION: An avulsion fracture was recognized in the distal end of the right radius. A fragmented fracture was identified in the scaphoid bone, and an internal fixator extending from scaphoid bone to lunate bone. The internal fixators were observed among the lunate, capitate, and distal end of the radius bones. The plain anteroposterior, lateral radiograph and CT of the right wrist exhibited a right-sided unilateral type III osseous coalition between the lunate and triquetrum bones. CONCLUSION: Knowledge of type III complete fusion is essential to the proper diagnosis and management of this variation when a subject exhibits unexplained wrist pain, trauma, or fracture. It should be noted that plain radiographs and CT can provide an accurate diagnosis in type III complete lunotriquetral coalition without pathological evidence.

Uric acid stimulates proliferative pathways in vascular smooth muscle cells through the activation of p38 MAPK, p44/42 MAPK and PDGFRß.

Hyperuricemia and angiotensin II (Ang II) may have a pathogenetic role in the development of hypertension and atherosclerosis as well as cardiovascular disease (CVD) and its prognosis. The purpose of this study was to investigate whether uric acid can induce proliferative pathways of vascular smooth muscle cell (VSMC) that are thought to be responsible for the development of CVD. The phosphorylation of p38 mitogen-activated protein kinase (p38 MAPK), p44/42 mitogen-activated protein kinase (p44/42 MAPK) and platelet-derived growth factor receptor ß (PDGFRß) was measured by Elisa and Western blot techniques to determine the activation of proliferative pathways in primary cultured VSMCs from rat aorta. Results demonstrated that uric acid can stimulate p38 MAPK, p44/42 MAPK and PDGFRß phosphorylation in a time- and concentration-dependent manner. Furthermore, treatment of VSMCs with the angiotensin II type I receptor (AT1R) inhibitor losartan suppressed p38 MAPK and p44/42 MAPK induction by uric acid. The stimulatory effect of uric acid on p38 MAPK was higher compared to that of Ang II. The results of this study show for the first time that uric acid-induced PDGFRß phosphorylation plays a crucial role in the development of CVDs and that elevated uric acid levels could be a potential therapeutical target in CVD patients.

Uterus retrieval in cadaver: technical aspects.

The authors describe uterus retrieval in cadavers. Uterine retrieval with its vasculature could be successfully achieved in four of the presented cases. Special attention was given to dissection of bilateral ureters and hypogastric vasculature. Uterine retrieval with its vasculature and supporting sacrouterine,vesicouterine peritoneal folds is an anatomically feasible procedure in preparation for uterus transplantation.

Provision 280 of the Turkish Penal Code: infringes on physician's dignity.

Every medical interference could be interpreted as an intervention into one's physical integrity and physical autonomy. This fact has brought along the necessity of determining the responsibilities of physicians, apotheosized throughout history from time to time, and to define the limits of the medical profession. The Turkish Penal Code (TPC) is the kind of legislation that imposes such limits. A revised version of the TPC has been in effect since June 1st, 2005. Ever since its enforcement, the TPC has attracted fierce criticism from several counts. However, Provision 280 is considered to be the most problematic one with regard to medical ethics. Along with several critical aspects, this provision stipulates almost a psychological violence for all health care professionals, particularly for the physicians as a matter of intervening with human dignity. The above-mentioned provision 280 needs to be annulled promptly in order to prevent physicians from remaining under psychological pressure while practicing their professions, as well as maintaining the moral values of the profession.

Critique of the "tragic case" method in ethics education.

It is time for the noon conference. Your job is to impart a career-changing experience in ethics to a group of students and interns gathered from four different schools with varying curriculums in ethics. They have just finished 1 1/2 h of didactic sessions and lunch. One third of them were on call last night. Your first job is to keep them awake. The authors argue that this "tragic case" approach to ethics education is of limited value because it limits understanding of moral problems to dilemmas; negates the moral agency of the student; encourages solutions that are merely intellectual; and suggests that ethical encounters are a matter for experts. The authors propose an alternative that focuses on three issues: the provider-patient relationship, the relationships between providers in the everyday world of health work and, the social position of healthcare providers in society. In this approach, teachers are not experts but more like guides on a journey who help students to learn that much of ethical practice comprises living through difficult situations of caring for vulnerable others and who help students to navigate some of these difficulties.

Co-existence of the pectoralis quartus and pectoralis intermedius muscles.

During the routine dissection studies on the right side of a 56-year-old female cadaver we encountered co-existence of the pectoralis quartus and pectoralis intermedius muscles. The pectoralis quartus originated from the costochondral junction of the fifth and sixth ribs, and then extended laterally under the border of pectoralis major muscle, but it was entirely separate from it. The pectoralis quartus formed a long flat band with an average width of 1.5 cm. It then inserted as an aponeurosis to the both of lateral lip of the intertubercular groove of the humerus and tendon of the short head of the biceps brachii muscle. Furthermore, the pectoralis intermedius muscle was a fleshy slip between the pectoralis minor and pectoralis quartus muscles and arose from the third and fourth ribs. It then united to the tendon of the short head of the biceps brachii muscle two cm below the coracoid process.

The physician and prison hunger strikes: reflecting on the experience in Turkey.

The medical ethics of a physician's relationship with a prisoner who is participating in a collective hunger strike has become a major public, professional, and governmental concern in The Republic of Turkey. This article examines the Turkish experience and debate about physician ethics during prison hunger strikes. It is hoped that this analysis will be of use to those formulating policy in similar situations.

Research ethics committees in developing countries and informed consent: with special reference to Turkey.

Research ethics committees (RECs) are the institutional equivalent of institutional review boards (IRBs) with respect to their role in the ethical analysis of research projects. In Turkey, as in most developing countries, these committees were initiated as a result of pressure from the Western scientific community. Since their formation, RECs have faced problems because of an underdeveloped scientific culture and the absence of established ethical standards. On the one hand, the standards of the RECs and IRBs in the developed world seemed too hard to achieve; on the other, some of the international regulatory rules, such as respect for autonomy, are not culturally sensitive. In addition to problems facing RECs, researchers have had difficulties in fulfilling RECs' requisites. Respect for autonomy is a good example for Turkey. The social construct of Turkish society is not based on the Western concept of autonomy; it is based on "collective autonomy," which is completely different from the Western definition. Cultural interpretation of concepts is the perception of concepts effected by their cultural connections with other concepts. For example, "motherhood" as a concept has many cultural connections, so when it is used we have to consider those culturally determined contexts. In some countries, the familiar concept and term are kept separated from the one that is imported. In others, the imported concept alters the original concepts content. Although its course varies in different countries, it always puts extraordinary pressure on RECs and researchers in their relationship between themselves and other parties with conflicting interests. In this article, some of the main concerns of RECs in developing countries are discussed, with special reference to Turkey. The universality of regulatory norms is questioned and the importance of culturally sensitive and effective safeguards emphasized.

Exercise training and axonal regeneration after sciatic nerve injury.

In the present study, we aimed to investigate the relationship between exercise training and peripheral nerve regeneration after crush injury. For this purpose, HRP neurohistochemistry and modified Pal-Weigert methods were used to assess the axonal regeneration. In the 2nd and 3rd regeneration week groups, myelin debris was observed, and there was no significant difference between exercise trained and sedentary groups. In the 4th regeneration week group, it was seen that myelin debris was removed, and some myelinated fibers were observed in the exercise trained group. On the other hand, there was no myelinated fiber in the sedentary group, and there was a significant difference between exercise trained and sedentary groups. Consequently, we think that exercise is effective in the 4th regeneration week.

Thrombosis After Splenectomy in Patients with Thalassemia.

Thrombosis is one of the most important complications after splenectomy and requires fast diagnosis, effective therapy and good follow-up. The aim of this study is to investigate the effects of thrombocytosis and natural inhibitors on thrombosis after splenectomy. We detected thrombosis in the portal vein system in 7 of the 30 splenectomized patients (23.3%) by Doppler Colour Flow Imaging. There was no statistical increase of thrombocyte count in patients with or without thrombosis. Natural inhibitor levels in all patients were lower than controls (p< 0.001), but there was not any statistical difference between the patients with and without thrombosis.

Serum zinc levels and zinc binding capacity in thalassemia.

Recently, it has been reported that serum zinc binding capacity (ZnBC) is a very important criterion to evaluate body zinc (Zn) status. It has been shown that chronic Zn deficiency occur in the patients with thalassemia major (TM). Zn deficiency in TM may cause hyperzincuria, high ferritin levels, hepatic iron load, hepatic dysfunction. This study was undertaken to determine serum Zn levels and ZnBC in different thalassemia forms and sickle cell disease (SCD). The study has been carried out on 30 Thalassemia Major (TM), 34 Thalassemia Intermedia (TI), 31 Thalassemia Trait (TT) and 10 SCD. As control group,13 healthy children and 20 adults were included. Serum Zn and ZnBC were determined by atomic absorption, then saturation index (SI%: serum Zn/ZnBC x 100) was calculated. Serum Zn levels in all patients were lower than control (p < 0.01). Serum ZnBC was at a normal level in patients with TT and TI but it was found to be lower in TM and SCD than control (p < 0.01). While serum Zn levels decrease and ZnBC increase in nutritionaL Zn deficiency, serum Zn levels decrease but ZnBC doesn't increase in patients with thalassemia.

Natural Inhibitors and Lipids in Patients with Sickle Cell Disease.

Microvascular occlusion in sickle cell disease (SCD) is a multifactorial process. Disordered coagulation may play a role in the pathogenesis of vaso occlusive crisis (VOC). The aim of this study was to evaluate the patients and to investigate their Protein C (PC), Protein S (PS) and AT-III levels during normal and crisis periods. A total of 18 patients with SCD were included in this study at the Antalya State Hospital, Thalassemia Center. The mean number of VOC episodes of the patients per year was 4.1 - 3.2. Complications in patients included 4 cases of osteonecrosis (23.5%), 2 cases of holealithiasis (11.7%), 2 cases of leg ulcers (11.7%), and 3 splenectomies (17.6%). The patients during noncrisis periods have lower cholesterol and higher triglycerides levels than the controls (p< 0.001). Hepatic and renal functions were normal in all patients. The mean totals of the PS, PC and AT-III levels were statistically lower both in non crisis and in crisis periods than the control (p< 0.001), but there was no statistical difference between the levels durining noncrisis and crisis periods. In conclusion, PC, PS and AT-IIII deficiencies in patients with SCD are certain. However, these deficiencies do not change during noncrisis and crisis situations and does not play a role on the period of crisis. Abnormal lipid patterns may be a predisposing condition for a crisis.

The narrative approach in teaching medical ethics: the Turkish experience.

The Deontology and Medical History Departments in Turkey teach Medical Ethics Education. These departments were first established by medical historians and for the time being the staff is primarily interested in deontology. The Department of Deontology in the Faculty of Medicine at Ankara University is the first department in Turkey to teach medical ethics. In 1974, issues including medical ethics were included in the current curriculum for the Medical Deontology and Medical History Course, but without changing the title of the course. Since then, different scholars have used different teaching methods. In this paper, a very new teaching strategy and technique used by the author will be discussed. In Turkey, the main resources being used as teaching materials in medical ethics are books and periodicals of mainly Western European and North American origin. Cultural, religious, and traditional characteristics of Turkey differ a great deal, so these texts need to be modified. This modification is hard to accomplish, because discourse on authentic values and value systems is inadequate. Also, this way of thinking about values is alien to most medical students. A narrative approach in teaching medical ethics aims to introduce local values that affect medical practice to first year medical students of the Faculty of Medicine at Ankara University, by searching for those values in literary texts and case histories. Besides introducing local values, some of our main goals are to encourage students to develop a sensitivity towards ethical issues and to teach them the methodology of ethical thinking. This is still a pilot study that covers only four hours of a thirty-hour program (two-hour sessions, twice in one semester), but some conclusions can be drawn. In this presentation, some information about the content and the structure of the course will be given, and the positive and negative results about the narrative approach will be discussed, arising from our limited local experience.

Continuous desferrioxamine infusion by an infusor in thalassaemia major.

Chelation therapy with desferrioxamine (DFO) can be an important problem for patients with thalassaemia major (TM). In an effort to find a solution to this problem, a new delivery system based on a disposable and lightweight device was developed by Baxter. The aim of study was to investigate the compliance of patients and the effects and side effects of two different infusors. The 26 patients using infusors were divided into 2 groups, who were infused with DFO for 48 h (group A) and for 120 h (group B). The 24-h mean urinary iron and zinc excretion in groups A and B were statistically significant at the beginning and end of therapy (p < 0.001). Serum ferritin levels decreased in both groups compared with control (p < 0.001). No systemic reactions were observed either during or at the end of treatment. The compliance and use of infusors were 97% in group A and 72% in group B. In conclusion, better compliance was achieved and there were fewer local complications in group A than in group B. Subcutaneous infusion of DFO with both devices may be ideal for patients who have compliance problems and cannot be treated using portable pumps. The device is new and expensive, but excellent and effective for long-term DFO infusion.

An anomalous digastric muscle with three accessory bellies and one fibrous band.

During our routine dissection studies we encountered an anomalous digastric muscle with three accessory bellies and one fibrous band in one embedded cadaver. All of these structures were attached to the mylohyoid raphe. This anomaly should be considered during surgical procedures involving this region.