The variations of peroneus digiti quinti muscle and its contribution to the extension of the fifth toe. A cadaveric study.

OBJECTIVES: To investigate the origin, prevalence, and possible effects of peroneus digiti quinti muscle (PDQ) on the fifth toe, to find out the variations of PDQ by determining the relationship between peroneus brevis muscle (PB) and PDQ, and to reveal its importance for the applications in foot and ankle surgery.  METHODS: This study was conducted at the Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey between September 2013 and June 2014. The study was a prospective dissection of cadaveric lower limbs. Twenty-five amputated lower limbs were stored in the freezer at -15°C. The legs were dissected; prevalence and variations of peroneus digiti quinti were investigated.  RESULTS: Peroneus digiti quinti muscle was found in 8 (32%) of 25 dissected lower limbs. However, 2 different tendon extensions were found at 3 (37.5%) of 8, and 5 (62.5%) of them were determined to have a single tendon.  CONCLUSION: The incidence, dimensions, length, and insertions of peroneus digiti quinti are important in the evaluation and treatment of functional loss of the fifth toe, lateral foot deformities, and tendon problems behind the lateral malleolus of the ankle.

Evaluation of method performance for oxidative stress biomarkers in urine and biological variations in urine of patients with type 2 diabetes mellitus and diabetic nephropathy.

BACKGROUND: Oxidative stress biomarkers such as superoxide dismutase (CuZnSOD), catalase (CAT) and malondialdehyde (MDA) play an important role in the pathogenesis or progression of numerous diseases. Data regarding the biological variation and analytical quality specifications (imprecision, bias and total error) for judging the acceptability of method performance for oxidative stress biomarkers in urine are conspicuously lacking in the literature. Such data are important in setting analytical quality specifications, assessing the utility of population reference intervals (index of individuality) and assessing the significance of changes in serial results from an individual (reference change value; RCV). MATERIALS AND METHODS: 20 patients with type 2 diabetes mellitus (T2DM), 20 patients with diabetic nephropathy (DN) and 14 healthy individuals as control were involved in this study. Timed first morning urine samples were taken from patients and healthy groups on the zero, 1st, 3rd, 5th, 7th, 15th and 30th days. Index of individuality and reference change value were calculated from within-subject and between-subject variations. Methods of oxidative stress biomarkers in human blood were adopted in human urine and markers were measured as spectrophotometrically. Also, analytical quality specifications for evaluation of the method performance were established for oxidative stress biomarkers in urine. RESULTS: Within-subject variations of oxidative stress biomarkers were significantly higher in patients with DN and T2DM compared to healthy subjects. MDA showed low individuality, and within-subject variances of MDA were larger than between-subject variances in all groups. However, CAT and CuZnSOD showed strong individuality, but within-subject variances of them were smaller than between-subject variances in all groups. RCVs of all analytes in diabetic patients were relatively higher, because of high within-subject variation, resulting in a higher RCV. Also, the described methodology achieves these goals, with analytical CVs of < 3.5% for all analytes. Goals for bias and total error were 6.0-7.9% and 12.5-23.3%, respectively. CONCLUSIONS: RCVs concept for predicting the clinical status in diabetic patients represents an optimization of laboratory reporting and could be a valuable tool for clinical decision. Furthermore, for oxidative stress biomarkers' measurements in urine, the desirable imprecision goals based on biological variation are obtainable by current methodologies.

Differences of the anterior segment parameters in children with down syndrome.

PURPOSE: The study was undertaken to investigate whether anterior segment findings are different in children with Down syndrome (DS) to normal children and to focus on its clinical significance. METHODS: A cross-sectional case control study was conducted in a total of 38 children with DS and 42 healthy children. This is the first report in the literature stating that. All subjects underwent ophthalmologic examination including slit-lamp biomicroscopy, cycloplegic refraction, intraocular pressure measurement and Scheimpflug imaging measurement. Customized software for Pentacam was used to analyze structural indices of anterior segment parameters. The mean anterior segment values of right eyes were compared between the groups. RESULTS: The mean anterior chamber parameters of patients with DS and controls were measured respectively: Corneal thickness was 502.31 ± 40.5 and 541.8 ± 37.42 mm (p < 0.001), corneal volume was 56.63 ± 4.5 and 61.02 ± 4.3 mm³ (p < 0.001), corneal radius curvature was 7.41 ± 0.29 and 7.67 ± 0.34 mm (p < 0.001), iridocorneal angle was 39.7 ± 6.2 and 39.5 ± 6.4° (p = 0.944), anterior chamber volume was 181.65 ± 27.38 and 185.77 ± 32.53 m³ (p = 0.528), anterior chamber depth was 3.08 ± 0.24 and 3.02 ± 0.31 mm (p = 447), pupil size was 2.95 ± 0.48 and 3.29 ± 0.45 mm (p < 0.05). CONCLUSION: The majority of the anterior segment parameters were found to be different in children with Down syndrome. While pupil size, corneal thickness, corneal volume and corneal curvature in DS were less than normal, iridocorneal angle, anterior chamber depth and anterior chamber volume were close to controls. The most important parametric differences in children with DS were seen on the cornea.

BMI and levels of zinc, copper in hair, serum and urine of Turkish male patients with androgenetic alopecia.

OBJECTIVE: Male pattern androgenetic alopecia is characterized by progressive hair loss from the scalp. It is known that imbalances of some trace elements play a role in the pathomechanism of many forms of alopecia. The aim of this study was to evaluate the levels of zinc and copper in hair, serum and urine samples of Turkish males with male pattern androgenetic alopecia and to compare with healthy controls. MATERIAL AND METHODS: 116 males with male pattern androgenetic alopecia and 100 controls were involved in this study. RESULTS: Levels of zinc and copper in hair were decreased significantly in the patients (p<0.05), although zinc and copper levels of serum and urine were not different between patients and controls (p>0.05). Body mass index of patients were higher than control group. In addition, in the group with body mass index of 25 and lower zinc level in hair and urine, copper level in serum were significantly higher (p<0.05). Body mass index was negatively correlated with hair zinc levels. CONCLUSION: We thought that decreased zinc and copper levels in hair may play a role in the etiology of male pattern androgenetic alopecia. In addition, obesity by making changes in the balance of the trace elements in hair, serum and urine may play a role in male pattern androgenetic alopecia. Hence, assessing the levels of trace elements in hair of male pattern androgenetic alopecia patients may be more valuable compared to serum and urine for treatment planning.

Medicinal plant extract (Ankaferd Blood Stopper) application in deep tissue injuries in rats: histopathological investigation of the effect on regional and systemic tissues.

BACKGROUND: This study was planned to evaluate both the histopathological changes under light microscope as well as the systemic organ effects following application of Ankaferd Blood Stopper® (ABS) (a mixture of five plant extracts) in an animal model of deep tissue hemorrhage. METHODS: A total of 50 Wistar Albino rats were divided into five groups of 10 rats each. The rats underwent femoral vein puncture and were treated with ABS tampon, ABS spray, or Surgicel, and one group was left untreated. After two weeks, each group underwent partial tissue excision from the same femoral region as well as from the brain, heart, kidney, and liver. RESULTS: The specimens from all groups were obtained from the femoral region after two weeks and evaluated under light microscope. The light microscope revealed no histopathological changes in neurovascular structures or in deep connective tissues in any of the groups. CONCLUSION: ABS provided hemostasis and was observed to stop bleeding. There were no histopathological changes at the tissue level and no pathological effects in other organs tissues under light microscope, and the remote organ tissue remained clear.

Corneal thickness measured by Scheimpflug imaging in children with Down syndrome.

PURPOSE: To measure corneal thickness via the use of a Scheimpflug imaging system (OCULUS Optikgeräte GmbH, Wetzlar, Germany) in children with Down syndrome. METHODS: This prospective, nonrandomized, clinical trial included children with Down syndrome and age- and sex-matched healthy controls. All subjects received a complete ophthalmologic examination. Corneal topography measurements were acquired by means of Scheimpflug imaging. Central corneal thickness (CCT), thinnest point of cornea (TP), and corneal volume (CV) were analyzed. RESULTS: A total of 27 children with Down syndrome and 37 control subjects were included in the study. In children with Down syndrome, the mean CCT was 494.27 ± 47 µm, the mean TP was 487 ± 49 µm, and the mean CV was 56.2 ± 6. In the controls, the mean CCT was 539.3 ± 40 µm, the mean TP was 538.0 ± 40.8 µm, and the mean CV was 61.3 ± 4. For all 3 parameters, the difference was statistically significant (P < 0.001). In the Down syndrome group, the CCT was <500 µm in 16 subjects (59.2%) and <450 µm in 5 (18.5%). In the control group, the CCT was <500 µm in 14 subjects (37.8%) and <450 µm in 2 (5.4%). CONCLUSIONS: In this study, corneal thickness was less in children with Down syndrome than in healthy control subjects. Decreased corneal thickness may be an early sign of a degenerative corneal disease such as keratoconus in children with Down syndrome.

A randomized pilot study of acupuncture treatment for primary dysmenorrhea.

OBJECTIVE: To compare the therapeutic effect of acupuncture and non-steroidal anti-inflammatory drug (NSAID) therapy in primary dysmenorrhea patients. STUDY DESIGN: Thirty-five young women with a diagnosis of primary dysmenorrhea were recruited for the study. Their dysmenorrhea severity was rated by visual analog scale (VAS) immediately prior to entry into the study. They were randomly divided into two groups; and the following month they were given NSAID (group 1, n=24) or acupuncture treatment (group 2, n=11). Pain was rated again using VAS during menstruation in both groups. RESULTS: After one month's treatment, pain scores were significantly lower in both groups (p<0.05). Mean pain scores decreased by 52.2% and 69.5% in the NSAID and acupuncture groups, respectively. CONCLUSION: Acupuncture was as effective as NSAID therapy for patients with primary dysmenorrhea. Since this was a pilot study with a small sample size and short follow-up period, larger studies are needed to clarify the effect of acupuncture in the treatment of primary dysmenorrhea.

Effect of atorvastatin and ezetimibe treatment on serum lipid profile and oxidative state in rats fed with a high-cholesterol diet.

INTRODUCTION: The effects of ezetimibe and atorvastatin on serum lipid profile and oxidant-antioxidant system were investigated in rats. METHODS: Seventy-two Sprague-Dawley rats were assigned to 6 groups. Group 1 was fed with standard rat chow. Group 2 and the other 4 groups were fed with a high-cholesterol diet: 10 mg/kg/d atorvastatin to group 3; 1 mg/kg/d atorvastatin to group 4; 10 mg/kg/d atorvastatin and 1 mg/kg/d ezetimibe to group 5; and 1 mg/kg/d ezetimibe to group 6. After 3 months, serum total, low-density lipoprotein, high-density lipoprotein cholesterol, and triglyceride levels, and the activities of malondialdehyde, glutathione peroxidase, and superoxide dismutase were measured in the plasma. In addition, the left anterior descending and femoral arteries were examined histopathologically. RESULTS: Serum total, low-density lipoprotein cholesterol, and triglyceride levels decreased slightly in group 3. However, administration of 1 mg/kg/d atorvastatin or 1 mg/kg/d ezetimibe did not significantly change lipid parameters. Plasma malondialdehyde levels slightly increased in group 2 compared with controls and decreased compared with both the atorvastatin regimens. However, malondialdehyde levels increased with the addition of ezetimibe to atorvastatin. Only the administration of ezetimibe significantly elevated the levels of malondialdehyde. Glutathione peroxidase and superoxide dismutase levels were also found to be significantly reduced in the groups receiving ezetimibe when compared with atorvastatin groups. CONCLUSIONS: Atorvastatin has a beneficial effect on oxidative stress in rats fed with high-cholesterol diet. A combination of ezetimibe with atorvastatin diminishes the beneficial effects of atorvastatin. Conversely, the sole administration of ezetimibe increases oxidative stress.

C2 intralaminar screw placement: a quantitative anatomical and morphometric evaluation.

AIM: To investigate the feasibility of placing a screw in the C2 lamina and evaluate the reliability of the surface of the dorsal arch of C2 as a landmark for determining the optimal site of screw entry. MATERIAL AND METHODS: 88 adult human C2 spines were used. Seven measurements were determined for screw entry points, trajectories, and lengths for placement of intralaminar screws. RESULTS: The average width of right C2 lamina (1/3 upper segment) was 2.6 mm (1.2 to 4.1 mm). The average width of left C2 lamina (1/3 upper segment) was 2.6 mm (1 to 4 mm). The average width of right C2 lamina (1/3 middle segment) was 4.9 mm (2.6 to 6.8 mm). The average width of left C2 lamina (1/3 middle segment) was 4.9 mm (2.3 to 7.6 mm). The average width of right C2 lamina (1/3 lower segment) was 5.7 mm (3.3 to 8.2 mm). The average width of left C2 lamina (1/3 lower segment) was 5.8 mm (2.2 to 9.6 mm). CONCLUSION: The width of the upper one-third of C2 lamina is not appropriate for the placement of intralaminar screws. On the other hand, the width of the middle and lower one-third of C2 lamina is more convenient for intralaminar screw delivery.

A previously undescribed anomaly of left anterior descending artery: type V dual left anterior descending artery.

Dual left anterior descending coronary artery (LAD) is a group of rare congenital coronary artery anomalies and exhibits 4 different types. The goal of this article is to define a new, previously undescribed type of dual LAD anomaly.

Magnetic resonance imaging is a complementary method to stereological measurement of testicular volume.

OBJECTIVES: The objective of our research was to determine the accuracy and precision of the Cavalieri principle with images obtained from magnetic resonance imaging (MRI) in estimation of the actual testicular volume in humans. METHODS: We performed volume measurements of 42 testes from 21 patients scheduled for bilateral orchiectomy for prostate cancer. We performed volume estimation measurements with ultrasonography (US), Prader's orchidometer (PrOM), and Cavalieri principle MRI (we used views in axial sagittal and planes) before orchiectomy. We measured actual testes volume with the fluid displacement technique after orchiectomy. Differences and correlations between estimated and actual volumes were evaluated. For all patients, we compared right and left testicular volumes independently with these measurements. RESULTS: Mean +/- SD actual testicular volume and estimated testicular volumes with US, PrOM, and Cavalieri principle using MRI axial and sagittal images were 15.3 +/- 3.3 and 17.7 +/- 3.0 cm(3), 20.0 +/- 3.5 cm(3), and 16.0 +/- 3.7 and 16.0 +/- 3.6 cm(3), respectively. Estimated and measured volumes were not different from each other. US and PrOM measured volumes were correlated with the actual volume. However, r-values with Pearson correlation test for estimated volumes measured with the Cavalieri principle with MRI were higher than US and PrOM (r-values were 0.934 and 0.961 vs 0.919 and 0.757, respectively). CONCLUSIONS: The results of this study demonstrate that testicular volume measurements with the Cavalieri principle using images obtained from MRI may be considered a complementary method to traditional techniques to estimate the actual testicular volume.

Morphometrical features of the human malleolar groove.

BACKGROUND: Our aim was to investigate the morphometric features of malleolar groove of the lateral malleolus in humans. METHODS: This study was performed on the malleolar grooves of 93 (80 dry and 13 cadaveric) fibulae. We measured the length of the fibula; length, width, and depth of the malleolar groove; the angle between malleolar groove and the fibular axis. Furthermore, we measured the distances between the distal tip of the fibula and the lateral and medial tubercles of lateral malleolus, and the width of posterior surface of the lateral malleolus. RESULTS: We found the shape of malleolar groove regularly concave in 63 out of 93 (68%) fibulae. The features of the triangular area at the posterior aspect of the lateral malleolus, where the peroneal tendons pass over, may serve as a bed for the peroneal tendons. There was a significant correlation between the depth of the malleolar groove and the distances between the distal tip of the fibula and the medial and lateral tubercles, as well (p<0.05). CONCLUSION: A strong correlation existed between either the shape of the groove or the values of the reference points. CLINICAL RELEVANCE: The shape of the groove may be important in reinforcing the superior peroneal retinaculum (SPR) and other structures restraining the tendons.

Bilateral aplasia of the tibialis anterior and unilateral aplasia of the extensor hallucis longus muscles.

A 35-year-old woman presented with bilateral leg pain on walking that had been present since childhood. Clinical examination showed bilateral absence of the tibialis anterior tendons and the left extensor hallucis longus tendon. Magnetic resonance imaging revealed that signal intensities in the location of the tibialis anterior muscles bilaterally and the left extensor hallucis longus muscle were uniformly high on T1-weighted images, consistent with fat tissue and aplastic muscles: findings not previously reported.

The effect of posterior bridging of C-1 on craniovertebral junction surgery.

OBJECT: The groove for the vertebral artery (VA) may be bridged on C-1, forming a canal through which the artery passes. Because this variant may significantly affect the commonly performed C-1 posterior laminectomy, the authors studied the incidence and radiological appearance of this anatomical feature in surgical specimens. METHODS: Anatomical measurements were performed using a Vernier caliper (accurate to 0.1 mm) on 166 dry C-1 vertebrae. In addition, a convenience sample of 172 cervical x-ray films was evaluated. Partial osseous bridging was detected in eight (4.8%), and a complete osseous bridge, forming the canalis arteriae vertebralis (canal for the VA), was seen unilaterally (eight on the left and two on the right) in 10 (6%) and bilaterally in eight (4.8%) of the dry vertebrae. On lateral radiography, a complete bone bridge was observed on nine (5.2%) and a partial bridge on 10 (5.8%) of the 172 studies. CONCLUSIONS: The discovery of a common variant may necessitate an immediate change in surgical management, and this anomaly could even increase the rate of surgery-related complications. The VA canal, present in the C-1 vertebra in approximately 5% of the specimens evaluated, was a variant that may be protective against VA injury. Knowledge of this variant may help the surgeon undertaking procedures in the C-1 region.

The comparative investigation of left ventricle papillary muscle arteries in different species.

OBJECTIVE: To determine whether similar histologic findings exist in left ventricle papillary muscle arteries in different species and to elicit whether those animal hearts may be used as models for human heart in experimental studies related to papillary muscles. METHODS: We examined 360 samples taken from the tip, mid-portion and base of papillary muscles in 60 normal adult hearts (15 each from human, dog, sheep, goat). The samples were obtained from Dicle University and Kahramanmaras Sutcu Imam University, Turkey and the study was conducted in June-September 2004. Tissues were processed by routine histologic methods, stained with hematoxylin-eosin and van giesson, and later evaluated under a light microscope. RESULTS: While the values of human and dog heart resembled each other by means of left ventricle papillary muscle arteries, the hearts of sheep and goat were also found to be similar. The number of thin walled arteries increased from the tip (18%) to the base (48%), intermediate walled arteries decreased from the tip (56%) to the base (14%), thick walled arteries decreased from the tip (62%) to the mid-portion (38%). The differences among human and animals were not statistically significant in any group. We found that the thickness values of papillary muscle arterial walls at the tip, mid-portion and base varied from 4.86 microm to 107.7 microm in all species. The difference among values of human and animals was not significant statistically (p>0.05). CONCLUSION: The values for arterial walls of tip, mid-portion and base of papillary muscles were similar between human and dog, sheep and goat. These morphologic findings in human and animal hearts of different species prove that anatomists, cardiologists, experimental investigators, pathologists and physiologists may benefit from the hearts of those animals as a good model to imitate the human heart in experiments concerning papillary muscles.

Effects of L-carnitine on oxidant/antioxidant status in acetic acid-induced colitis.

Recently, the role of oxidative stress in the pathogenesis of ulcerative colitis has been investigated. This study was designed to evaluate the possible beneficial effects of L-carnitine on tissue injury and oxidative stress in acetic acid-induced colitis in rats. Acetic acid administration induced severe damage macroscopically and histopathologically in colon and significantly increased the levels of malondialdehyde and myeloperoxidase in colonic tissue. Supplementation of L-carnitine to acetic acid-treated rats did not prove to induce any improvements in macroscopic scores, while L-carnitine administration improved histopathologic scores and significantly decreased malondialdehyde and myeloperoxidase levels in treatment groups. Acetic acid administration significantly decreased reduced glutathione, superoxide dismutase, and catalase levels in colonic homogenate. Supplementation of L-carnitine prevented the depletion of reduced glutathione levels but significantly increased superoxide dismutase levels. On the other hand, no significant change in catalase activity was observed. In conclusion, these results may reflect that L-carnitine could be beneficial as a complementary agent in treatment of ulcerative colitis.

Influence of ovariectomy and flutamide treatment on vaginal tissue and body weight.

OBJECTIVE: To determine the effect of flutamide on vaginal histology, and to ascertain whether flutamide regulates body weight gain in the ovariectomized rat model. METHODS: We chose 36 sexually mature female Wistar-Albino rats in this study. The study took placed in the Department of Medical Science Application and Research Center of Dicle University, Diyarbakir, Turkey, in 2002. We divided the model rats into 3 groups: group 1--control group, group 2--sham-operated group and group 3--bilaterally ovariectomized group. In addition, we gave flutamide to group 3. RESULTS: We found that the body weight was higher in the ovariectomized rats than the control rats. Furthermore, the body weight decreased a little after flutamide therapy. The thickness in the vaginal epithelium of the control group decreased, moreover, the appearance of stromal tissue was rather loose. After flutamide applications, infiltration of the stromal cells increased, the vaginal epithelial layer thickened and became keratinized. Microscopic papillae and anatomical processes appeared in the flutamide treated group. CONCLUSION: We observed that the antiandrogen drug flutamide is hormonally active and may exhibit estrogenic-antiestrogenic activity in rats. Our study may be a source for further research examining the relationship between the androgen receptor antagonist flutamide and reproductive function in female rats.