Posterior Wall Defect of Sacrum: An Anatomical Study of Sacral Spina Bifida.

AIM: To investigate the incidence, types, morphological and morphometric properties of spina bifida on dry sacral bones. MATERIAL AND METHODS: 110 dry adult sacrums gathered from the bone collections of the Laboratory of the Anatomy Department of Dokuz Eylul University School of Medicine were examined. The parameters analysed were: 1) results of parameters related to the posterior sacral wall; 2) classification and rate of the closure defects; 3) classification of the top sacral vertebrae according to the shape of its superior surface; 4) presence of sacralisation and lumbalisation among sacrums with dorsal wall defects; 5) vertebral levels of apex of the sacral hiatus; and 6) vertebral levels of closure defects of the sacrums. RESULTS: We determined 22/110 (20%) sacrums demonstrated spina bifida. Of these 22 sacrums, 4 (18.18%) showed complete and 18 (81.82%) showed incomplete spina bifida. We noted the coexistence of spina bifida with sacralisation (6/22 [27.27%]) and lumbalisation (5/22 [22.73%]). The types of defects were described and grouped as ?V? (Type 1), inverse ?V? (Type 2), window (Type 3), foramen (hole) (Type 4), sand watch (Type 5), narrow linear (Type 6), wide linear (Type 7), and bridged (Type 8). The shape of upper surfaces of the sacrums with spina bifida was grouped as: cavity (20/22, 90.9%), hump (1/22, 4.5%), and flat (1/22, 4.5%). CONCLUSION: A precise definition of the anatomical variations of sacrums is essential for surgeons, particularly when operating using endoscopic techniques and for anaesthesiologists applying caudal epidural block.

Radiological and Surgical Anatomy of Ventral C1-C2 Complex.

AIM: To evaluate anatomical data of the bony structures during exploration of the C1-C2 complex. MATERIAL AND METHODS: This study included six formalin-fixed cadaveric head and neck specimens. Radiological images and anatomical measurements included: C1-C2 distance, bony distance between C1 anterior tubercle-nares and superior incisors, height of C1 anterior arch, and height and width of odontoid articular surface. RESULTS: The mean distance between C1 anterior tubercle-nares and superior incisors on maxilla were 96.16 ± 8.07 mm and 84.14 ± 9.16 mm, respectively. The mean height of C1 anterior arch was 13.89 mm. The meandistance between medial borders of right-left C1 lateral masses was 19.10 ± 1.80 mm. The mean distance between medial border of lateral midline on mass right and left sides were 9.43 ± 0.88 mm and 9.68 ± 0.97 mm, respectively. The mean height of C1 anterior arch at midline was 13.89 ± 2.48 mm, and the mean distance between ventral surface of anterior arch and ventral joint of odontoid at midline was 6.43 ± 1.29 mm. The anteroposterior, horizontal diameters of odontoid on its base were 12.12 ± 0.38 mm, and 11.12 ± 0.94 mm, respectively. The angles of transoral and transnasal approaches to C1 were 32.67 ± 4.59° and 32.00 ± 2.10°, respectively. CONCLUSION: A safe transoral or transnasal odontoidectomy requires accurate measurements and imaging regarding ventral C1-C2 relationships, distances of odontoid, lateral mass and midline.

Cerebellar volume in early-onset schizophrenia and its association with severity of symptoms.

OBJECTIVES: This study aimed to investigate whether early-onset schizophrenia (EOS) cases differ from controls regarding volumes of the total cerebellum and the right and left cerebellar hemispheres, and volumetric asymmetry. Correlations of cerebellar volumes and asymmetry indices with severity of symptoms and general functioning in cases of EOS were also assessed. METHODS: Adolescents with EOS (n = 23) were compared with controls (n = 23). Sociodemographic and clinical data, and magnetic resonance imaging scans that were acquired for routine clinical purposes were collected retrospectively. Cerebellar volumes were evaluated using the stereological method. Asymmetry indices were subsequently calculated. Scores of the Positive and Negative Syndrome Scale and the Children's Global Assessment Scale were used to assess the severity of symptoms and general functionality. RESULTS: There were no significant differences in any of the cerebellar volumes and asymmetry indices between the two groups. Neither cerebellar volumes nor asymmetry indices were correlated with the severity of symptoms and general functionality in EOS. CONCLUSIONS: Our findings suggest that the early-onset form of schizophrenia does not show apparent volumetric changes of the cerebellum. Additionally, the neural circuits involved in formation of symptomatology may not reflect any correlation with cerebellar volumes at mid-adolescence.

Anatomical and Radiological Investigation of Dry Bone Adult Mandibles Having Impacted Third Molar Teeth.

OBJECTIVE: To investigate the incidence of the impacted mandibular third molars in dry bones adult mandibles. METHODS: The 198 dry bones adult mandibles gathered from the bone collections in Laboratory of the Anatomy Department of Dokuz Eylul University School of Medicine were macroscopically examined for the presence of impacted mandibular third molars. The genders of the adult bones were unknown. The adult mandibles having impacted third molars were photographed with Canon 400B (55 mm objective). The mandibles having impacted third molars were also radiographically examined with orthopantomography (a dental radiographic technique, kV 60, mA 2.0) in radiology unit of Faculty of Dentistry, Ege University. The impacted teeth were grouped according to their position and degree of impaction. RESULTS: The each of 2 of 198 adult mandibles (2/198; 1.01%) was having an impacted 3rd molar teeth. These 2 molar teeth were belonged to class 1, B and partially buried, vertically oriented. The first impacted 3rd molar teeth was located on the left side of the one mandible and the second one on the right side of the other mandible. CONCLUSION: The present study provides information about impacted mandibular 3rd molar in dry bones.

Surgical anatomy of neurovascular structures related to ventral C1-2 complex: an anatomical study.

OBJECTIVE: Transoral odontoidectomy and ventral C1-2 stabilization are important surgical procedures, performed to decompress ventral spinal cord, and to stabilize craniovertebral junction. These procedures require knowledge regarding surgical anatomy of neurovascular structures ventral to the C1-2 complex. The aim of this study is to evaluate the relationships between neurovascular structures and bony landmarks in ventral atlantoaxial complex. MATERIALS AND METHODS: This study was performed on six formaldehyde fixed cadaveric head and neck specimens. Relevant anatomical parameters, including distances from the midsagittal line to internal carotid arteries (ICA), vertebral arteries (VA), and hypoglossal nerves (HN), were measured using electronic calipers. RESULTS: The mean distance between ICA and midsagittal line was observed as 26.13 mm at the level of axis and 24.67 mm at the level of the atlas. The mean distance between VA and midsagittal line was observed as 15.38 mm at the level of axis and 26.54 mm at the level of the atlas. The mean distance between HN and midsagittal line was observed as 33.27 and 33.58 mm at the level of the atlas and axis, respectively. CONCLUSION: This study confirmed that ICA and HN proceeded ventrally or laterally along the lateral aspect of the C1 lateral mass; therefore, the area located ventrally along the medial components of the C1 lateral mass was the safe zone for anterior surgical approach.

The Morphological Grading and Comparison of Sutural Patency Among Cranial Sutures in Dry Human Skulls.

OBJECTIVE: To investigate the degree of fusion (patency) among cranial sutures in human dry skulls in the Anatolia. METHODS: One-hundred fifty-eight human dry skulls that were accepted as adults according to the teeth eruption were macroscopically examined and photographed with Canon 400B (55 mm objective). The grades of fusion of coronal, sagittal, and lambdoid were quantitatively analyzed by using the modified grading scale. According to the extent of patency, the sutures were graded as grade-0 (open), grade-1 (fused but not obliterated), grade-2 (50%< obliterated), grade-3 (50% > obliterated), and grade-4 (100% obliterated). The authors determined and compared the rate for each grade of sutural patency on coronal, sagittal, and lambdoid sutures. RESULTS: The cranial sutures of 4 cranii (4/158; 2.53%) had grade-4 fusion, whereas there were no any cranii with sutures of grade-0 fusion. The number of each grade of fusion among cranial sutures of 158 skulls, in descending order, was as follows: 171 (grade-3), 145 (grade-1), 133 (grade-2), and 25 (grade-4). The grade-4 fusion was significantly less observed than the others. The grade-1 and grade-4 fusion of lambdoid sutures were established as the most (66/41.8%) and least (5/3.2%) common fusions among cranial sutures, respectively. The frequencies of each grade of fusion for each cranial suture were determined in a descending order: coronal (grade-3 > 2 > 1 > 4), sagittal (grade-3 > 2 > 1 > 4), and lambdoid sutures (grade-1 > 3 > 2 > 4). The frequency of grade-1 fusion of lambdoid suture (66/41.8%) was significantly different when compared with coronal (39/24.7%) and sagittal sutures (40/25.3%), respectively. CONCLUSION: The grades of fusion (or sutural patency) vary among cranial sutures.

Foramen arcuale: a rare morphological variation located in atlas vertebrae.

OBJECTIVE: To investigate the incidence of foramen arcuale in dry atlas vertebrae which may cause clinical problems. MATERIALS AND METHODS: Eighty-one dry human cervical vertebrae were examined. The evaluated parameters of two atlas vertebrae including foramen arcuale were as follows: maximum antero-posterior, transverse diameters and areas of the right and left superior articular facets and transverse foramina; maximum antero-posterior diameters, heights, areas and central sagittal thickness of bony arch forming roof of foramen arcuale, respectively. All parameters were measured with caliper in milimeters. RESULTS: Thirteen of eighty-one cervical vertebrae specimens (13/81, 16.05%) were atlas and the two of thirteen atlas vertebrae (2/13, 15.38%) had macroscopically complete foramen arcuale. Each of the two atlas vertebrae was including one foramen arcuale (one on the left and one on the right side). There was a statistically significant difference (p = 0.04) between the mean antero-posterior diameter of superior articular facet located on each side of atlas vertebrae, whereas not (p = 0.51) between mean antero-posterior diameter of transverse foramina. There was not any significant difference between the mean transverse diameters and areas of superior articular facets and transverse foramina located on each side of atlas vertebrae, respectively. Each of the areas of transverse foramina located on the same sides with foramen arcuale in two atlas vertebrae was less than the mean areas of transverse foramina located ipsilateral side with each foramen arcuale in thirteen atlas vertebrae. CONCLUSION: The present study provides additional information about the incidence and topography of the atlas vertebrae including foramen arcuale.

Morphological and Morphometric Analysis of Foramen Magnum: An Anatomical Aspect.

OBJECTIVE: To investigate the detailed morphological and morphometric analysis of foramen magnum (FM) in dry cranii. METHODS: One hundred fifty skulls of unidentified sex were macroscopically examined and were photographed with Canon 400B (55 mm objective). According to tooth eruption of the skulls, they were accepted as adults. None of the examined skulls showed signs of prior cranial surgery, malformation, or trauma. The evaluated study parameters that were recorded with Vernier caliper in millimeter were as follows: antero-posterior diameter from Basion to Opisthion, transverse diameter (largest distance between the lateral margins of the FM), and the shape of the FM (Fig. 1). The shape of the FM was determined according to FM index that was calculated by dividing antero-posterior diameter by transverse diameter. When FM index was found greater than or equal to 1.2, the foramen was accepted to be oval in shape. Whereas the FM index was found less than 1.2, the foramen was accepted to be round in shape The area of the FM was calculated by using 2 different formulas as described previously by Radinsky (/4 × π × w × h) and Teixeira (π × {(h + w)/4}2), and "π" was accepted as 3.14 in both formulas. RESULTS: The results of descriptive statistics and areas of the FMs were presented in Table 1. The mean antero-posterior diameter and transverse diameter of anteroposterior diameter by transverse diameters were found as 34.38 ±â€Š2.38 and 28.95 ±â€Š2.19, respectively. The mean area of the FMs estimated by Teixeria formula was determined significantly larger than the mean area of the FMs estimated by Radinsky formula (P <0.001). According to estimated FM index of the 150 adult dry skulls, 87 (58%) of skulls were described as being round in shape and 63 (42%) of skulls were described as being oval in shape (Fig. 1). CONCLUSION: The surgeons must comprehend regarding the detailed morphological and morphometric features of FM to avoid vital complications during the surgical procedures.

Double-sling procedure for the surgical management of stress urinary incontinence with concomitant anterior vaginal wall prolapse.

PURPOSE: To assess the safety, efficacy of double-sling procedure (DS) for the surgical management of stress urinary incontinence (SUI) with concomitant anterior wall prolapse (AVWP) and to identify if less synthetic material implantation will decrease the complication rates without decreasing the high cure rates. METHODS: We reviewed the women who underwent DS in two institutions from January 2009 to December 2013. In DS, there are two transobturator tapes inserted from two different routes for the surgical management of SUI with concomitant AVWP. POP-Q was used for anatomical evaluation of prolapse. SUI was assessed by cough stress test and ICIQ-SF questionnaire. We accepted that the patient was satisfied if the visual analog scale score was ≥80. The severity of urinary incontinence was classified by ICIQ-SF. The women were evaluated at the 3 and 12 months and annually. RESULTS: A total of 74 women met the requirements for inclusion and had sufficient records for analysis. The mean follow-up period was 35.4 months (range 12-60). Operative time was 33.2 ± 6.2. The objective cure and subjective success rates of SUI were 87.8 and 93.2 %, respectively. The satisfaction from the surgery was also high with 86.5 % rate. The anatomical success in our series was rather high with 96 % rate. Our overall complication rate was 12.2 %. Mesh extrusion rate was 0 %. CONCLUSIONS: Double-sling procedure is feasible, efficient, and safe. Reducing the mesh size did not have a detrimental effect on the outcomes of SUI treatment and simultaneous AVWP repair.

Grape seed extract has superior beneficial effects than vitamin E on oxidative stress and apoptosis in the hippocampus of streptozotocin induced diabetic rats.

We aimed to investigate the effects of grape seed extract (GSE) and vitamin E (Vit E) on oxidative stress and apoptosis in the hippocampus of streptozotocin-induced diabetic rats. In Control, Diabetic, and Diabetic treated with GSE (Diabetic+GSE) and vitamin E (Diabetic+Vit E) groups, oxidative stress index (OSI), TUNEL staining and Bcl-2, Bcl-XL, Bax, caspase-3, -9, and -8, Cyt-c, TNF-α, and NF-κB gene expressions were evaluated. OSI was significantly increased in the plasma and hippocampus of the Diabetic compared to Control group and decreased in Diabetic+GSE and Diabetic+Vit E groups compared to Diabetic. TUNEL positive neurons significantly increased in the hippocampus of the Diabetic group compared to Control and decreased in Diabetic+GSE (more prominently) and Diabetic+Vit E groups compared to Diabetic. In the hippocampus of the Diabetic group, Bcl-2 and Bcl-XL gene expressions were significantly decreased; Bax, caspase-3, -9, and -8, Cyt-c, TNF-α, and NF-κB gene expressions were significantly increased compared to Control. In Diabetic+GSE and Diabetic+Vit E groups, Bcl-2 gene expressions were significantly increased; Bcl-XL gene expressions did not differ compared to the Diabetic group. The expression of Bax, caspase-3, -9, and -8, Cyt-c, TNF-α, and NF-κB genes in the Diabetic+GSE group and the expression of caspase-3 and -9, TNF-α, and NF-κB genes in the Diabetic+Vit E group were significantly decreased compared to Diabetic. In conclusion, GSE (more prominently) and vitamin E decreased oxidative stress and neuronal apoptosis occurring in the hippocampus of diabetic rats.

Estimation of stature and sex from sternal lengths: an autopsy study.

The aim of this study was to derive regression equations for estimating stature and further to estimate sex from four measured sternal lengths. This study included intact sterna from 65 males and 30 females, aged between 25 and 40 years, obtained during medico-legal autopsies. Stature and four sternal lengths, length of the manubrium (LM), length of the body (LB), length of the manubrium and body (LMB) and total sternal length, of each cadaver were measured. Stature and all measured sternal lengths were greater in males compared to females (p < 0.001). All sternal lengths were positively correlated with stature in sexes. LMB had the highest correlation coefficient in both males and females (correlation coefficient: 0.721 and 0.740, respectively). In both sexes, linear regression analysis for stature estimation revealed equations with the highest R (2) values when derived from LMB (R (2) = 0.521 for males and R (2) = 0.547 for females). On the other hand, only the multiple linear regression equation derived from the combination of the LB and LMB had the higher R (2) value (R (2) = 0.640) for stature estimation in females. Receiver-operating curve analysis for all measurements was statistically significant (p < 0.05 for all). These findings suggested that measured sternal lengths can be used for estimation of sex. However, LB and LMB measurements were found to be the most reliable sternal lengths for estimating sex with an accuracy rate of 90 %. Our results revealed that the sternum is a useful tool for estimating stature and sex when other skeletal bones are not available.

Effect of nifedipine on hippocampal neuron number in penicillin-induced epileptic rats.

AIM: Epileptic seizures lead to neuronal loss in the hippocampus. Experimental epilepsy can be induced by direct application of various chemicals to cerebral cortex. Nifedipine is an L-type voltage-dependent calcium channel blocker. In spite of several studies that show the seizure-suppressing effects of nifedipine, it has been shown that nifedipine does not suppress but conversely increases epileptic seizures. Similarly, contradictory effects of nifedipine have been reported, such as neuroprotection, failed neuroprotection and neurotoxicity. We therefore aimed to investigate the effect of nifedipine on hippocampal neuronal loss in penicillin induced epileptic rats in this study. MATERIAL AND METHODS: The effect of nifedipine on total hippocampal neuron number was estimated by using the optical fractionator method (an unbiased stereological method) in penicillin-G induced epileptic rats. RESULTS: The total number of hippocampal neurons in the control group was 183687 ± 3184. In the penicillin-induced group, the total neuron number significantly decreased to 146318 ± 3042 compared to the control group. In the nifedipine group, the neuron number significantly decreased to 128873 ± 1157 compared to both control and penicillin-induced groups. CONCLUSION: Nifedipine increased neuronal loss and did not suppress epileptic seizures in penicillin-induced epileptic rats. Nifedipine could not protect against hippocampal neuronal loss in penicillin-induced epileptic rats.

Effect of testosterone propionate on hippocampal pyramidal neuron number in female rats.

INTRODUCTION: The hippocampus is an important region of the brain that regulates cognitive and emotional functions. In this study, we examined the impact of perinatal administration of testosterone propionate (TP) on the number of pyramidal neurons in the CA1 and CA3 regions of the hippocampi of female rats. METHODS: Five groups of rats were used in this study. Three groups of female rats were administered TP in either both the prenatal and the postnatal periods (Group 1), only the prenatal period (Group 2) or only the postnatal period (Group 3). The other two groups of rats included control females (Group 4) and control males (Group 5). The rats were sacrificed on postnatal Day 120 and their brains were analysed for hippocampal pyramidal neuron number using stereological methods. RESULTS: Control male rats (Group 5; p = 0.043) and TP-treated female rats in Groups 1 (p = 0.012) and 2 (p = 0.037), but not Group 3 (p > 0.05), had a significantly higher number of pyramidal neurons than control female rats (Group 4). The rats in Group 1 had the highest number of pyramidal neurons among the female rats. CONCLUSION: Perinatal TP treatment has an augmenting effect on the number of pyramidal neurons in the hippocampi of female rats. We also found gender-based differences in the hippocampi of male and female rats, with a higher number of pyramidal neurons seen in male rats. Continuous TP administration during the prenatal and postnatal periods is more effective than administration only in the prenatal or postnatal period.

Anatomopathological findings in hangings: a retrospective autopsy study.

BACKGROUND: In this retrospective autopsy study, we aimed to review the anatomopathological findings observed in cases of hanging death for a five year period and to evaluate the role of contributing factors such as age, sex, type of hanging and localization of the ligature knot. METHODS: Autopsy reports of 102 hanging cases performed by the Department of Forensic Medicine, Faculty of Medicine of Pamukkale University, between January 2007 and September 2011, were retrospectively reviewed. RESULTS: In the 102 hanging cases 73 of the victims were males (71.6%) and 29 (28.4%) were females, with a mean age of 40.97 ± 17.41 years. All cases were suicidal hanging. Fifty four cases (52.9%) were typical hanging, with the ligature knot located posteriorly. There were petechial hemorrhage on the face and eye lids in 46 (45.1%), ecchymoses of the cervicale muscles in 43 (42.2%), and fractures of the neck structure(s) in 69 cases (67.6%). CONCLUSIONS: The incidence of neck structure fractures increased with age. In addition, there was no correlation between the incidence of neck structure fractures and sex or type of hanging.