The superior hypogastric plexus (SHP) contains afferent nociceptive fibers from the pelvic structures, thus the SHP block is employed in the chronic pelvic pain (CPP) treatment in patients who do not respond to conservative treatments. A 60-year-old female patient, who did not respond to conservative treatment, underwent SHP neurolytic block after a successful diagnostic block. An excessive oblique angle approach was applied due to physical restrictions, the needle passed through the intervertebral disc resulting in the contralateral side SHP block, and the procedure was also repeated to the other side SHP. After the procedure, improvement in the patient's NRS score and a decrease in urination frequency were detected, and these positive effects were preserved for 3 months. SHP block is a safe alternative interventional procedure in patients with CPP. If an excessive oblique angle is applied during the procedure, the needle may cross the midline, resulting in a contralateral blockage.

AIM:To investigate the difference in the length of C1 laminectomy between the right and left sides and to determine the importance of considering the dominant vertebral artery in reducing complication risks. MATERIAL AND METHODS:Five caucasian male cadavers were studied. The distance of the C1 posterior tubercle to the vertebral groove (A), the length of the vertebral groove (B), and the diameter of the vertebral artery were measured and statistically investigated. Computed tomography scans were also obtained from all cadaver specimens. RESULTS:The mean distance of the C1 posterior tubercle to the vertebral groove (A) on the right side was 20.20 ± 2.16 mm and on the left side was 16.40 ± 2.88 mm. The mean distance of the vertebral groove (B) on the right side was 13.80 ± 0.83 mm and on the left side was 17.60 ± 0.89 mm. The mean diameter of the vertebral artery on the right side was 3.58 ± 0.83 mm and on the left side was 3.70 ± 0.10 mm. CONCLUSION:The vertebral groove was longer on the dominant artery side. Therefore, the dominant and nondominant sides have different lengths of safe C1 laminectomy areas. The length of the laminectomy area to be performed on the dominant artery side is shorter than that on the nondominant side. In cases in which the C1 posterior arcus must be removed for decompression, asymmetric decompression should be performed to reduce the risk of vertebral artery injury.

PURPOSE:The purpose of this study was to investigate the morphologic and morphometric features of the pisiform using various anatomical landmarks, and to analyze its topographic relationship with surrounding bony structures. METHODS:Unilateral CT images of the hand and wrist taken from 208 patients (62 females, 146 males) admitted to Radiology Department of Marmara University Faculty of Medicine between 2014 and 2019 retrospectively analyzed in the study. The mean age of the subjects was 33.4 (range, 14-65) years of age. Eight different measurements were performed using 3D Slicer software and one novel classification was made on the images of 117 (56.25%) right and 91 (43.75%) left hands taken in neutral position. The results were further compared between gender, laterality, and age groups. RESULTS:The mean values of the truncated hand length (THL), longitudinal diameter of pisiform (LDP), transverse diameter of pisiform (TDP), and piso-triquetral distance (PTD) were significantly higher for men than for women. No significant difference was found between the right and left side measurements. A significant difference was also observed in PTD values between the age groups. The novel classification used in the present study revealed that the most common shape of triquetral facet of the pisiform was ellipse type (85.6%), followed by round (10.1%), and cylindrical (4.3%) types, respectively. CONCLUSION:The results of the study provide comprehensive morphologic and morphometric data for the pisiform and may lend support for better understanding of the region which would be beneficial for the surgical interventions of the hand and wrist.

Approaches for the induction of neurogenesis and neuronal recovery through several modalities are gaining popularity in Parkinson’s disease (PD). Growth hormone (GH) seems to have a role in the reversal of neural function following brain injury as well as in normal brain development and function; therefore, the use of GH may represent a feasible strategy in the management of PD. This experimental study aimed to evaluate the effect of growth hormone on motor function and dendrite morphology in rats with 6-hydroxydopamine (6-OHDA)-induced PD model. Thirty-six Sprague Dawley rats were included and randomly allocated into one of the six study groups: two controls and four treatment groups that received daily subcutaneous growth hormone injections for 21 days, 1, 2, and 3 months. PD model was induced through unilateral 6-OHDA injection to the nigrostriatal pathway. The following assessments were made: apomorphine rotation test, stepping test, and tissue examinations for tyrosine hydroxylase and dendrite morphology. The apomorphine rotation test and the stepping test confirmed the presence of PD. These tests as well as dendritic spine density/number and length assessments showed improvement in PD findings over time with GH administration. Findings of this study suggest that GH administration may improve dendrite morphology and motor function in the PD model, which may translate into symptom relief and quality of life improvement in patients with PD. Such potential benefits should be tested in robust clinical studies.

Anatomical variations include the absence of a muscle or tendon or its presence as an accessory muscle or tendon. Clinically, anatomic variations play an important role in diagnosis and theraphy. In anatomy dissection laboratory, during routine dissection for educational purposes, a 83 -year- old male cadaver was dissected and a two-headed accessory muscle was observed on the plantar surface of the left foot. The medial and lateral heads of the muscle were observed close to the medial and lateral plantar neurovascular bundles. The accessory muscle was pierced by the tendon of the flexor digitorum longus muscle and both muscles were inserted to the distal phalanx of the fifth toe. The variations of the accessory muscles should be taken into consideration in surgical interventions, since, they may change the course of the intervention or as in the case of abductor hallucis muscle, they may be used in reconstructive procedures as grafts. Therefore, it is crucial for surgeons, orthopedic physicians, and anatomists to have a detailed knowledge of the intrinsic muscles of the foot.

Objective: Aim of this study is investigation of the risk of vertebral artery injury on the dominant and non-dominant vertebral artery sides at the craniocervical junction on cadavers . Methods: A total of five cadavers and 10 vertebral arteries injected with red latex were studied. Dissection was performed on all of the cadavers. The study also involved CT scans obtained from all of the cadaver specimens. Distance of C1 lateral mass medial wall to the V3 segment of the vertebral artery, distance of C1 lateral mass lateral wall to the V3 segment of the vertebral artery, distance of C2 pedicle medial wall to the V3 segment of the vertebral artery, and distance of C2 pedicle lateral wall to the V3 segment of the vertebral artery were measured and statistically analyzed. Results: There was no statistically significant difference between anatomical measurements on cadavers and on CT scan measurements. The data in the study demonstrated that the non-dominant (hypoplastic) vertebral artery follows a much closer course to the pedicle and the lateral mass, compared to the dominant artery. Conclusion: In conclusion, it has been shown that the vertebral artery may be easily injured during surgical procedures due to the anatomical proximity of the pedicle and lateral mass and the screws’ entry points being much closer on the non-dominant side.

Forty-five mandibles (90 cases) used in education at the Anatomy Departments of Bezmialem Vakif University, Hitit University and Marmara University Faculty of Medicine were examined macroscopically and the incidence of mylohyoid bridge was investigated. In some cases, the proximal part of the mylohyoid groove (sulcus mylohyoideus) may appear as a canal through a bony bridge (mylohyoid arc = mylohyoid bridge). Knowledge the frequency of mylohyoid bridge variations will contribute to the literature studies on this subject and will guide the practice of oral surgery and dentistry. Investigating anatomical variations, as well as collecting anthropometric data, is important to draw attention to clinical practices and guide clinicians.

OBJECTIVE: A novel posteriolateral surgical approach is described that will provide safe access to intradural and extradural lesions located in the anterior part of the spinal cord (SC) at the C1-2 level and to the odontoid in single session. METHODS: A total of five cadavers and two dry C1 vertebrae were used in this study. The study involved obtaining computed tomography magnetic resonance imaging scans and magnetic resonance imaging of all cadaver groups before and after the procedures. Group 1: Control; Group 2: Unilateral C1 posterior arch was removed, the inferomedial part of C1 lateral mass was removed, and access the anterior and lateral aspects of the SC. Group 3: In addition, odontoid was removed, Group 4: In addition, - nilateral C1C2 screw was placed. Group 5: In addition, bilateral C1 -C2 screw was placed. RESULTS: The median distance from the midpoint of C1 posterior tubercle to vertebral groove which was removed in groups is 21.4 +/- 2.88 mm. The average width of C1 lateral mass was 13.4 +/- 2.4 mm. After the lateral mass was drilled, its width decreased to 10,2 mm. This area was sufficient to open a surgical corridor and reach the anterior of SC and odontoid. After the procedure, no instability was found in group 2 without instrumentation on computed tomography and magnetic resonance imaging scans. CONCLUSIONS: It is possible to access the anterior C1C2 via a posterolateral paramass approach by drilling 20% - 30% of the lateral mass, providing an open pathway for easy intervention in C1C2 intradural lesions. It is also possible to perform odontoid resection using this approach.

Objective: The cranial base harbours numerous foramina, and the anatomical properties of the foramina are crucial in clinical interventions. The purpose of the current study is to evaluate possible asymmetries regarding the middle and posterior cranial fossae foramina using 3D reconstructions of high-resolution computed tomography (CT) images. Patients and Methods: High-resolution cranial CT images of 253 female and 287 male adult patients were used in the study. The patients were 18 to 40 years of age without any apparent cranial pathology. The distances from the foramen rotundum, foramen ovale, foramen spinosum, internal acoustic meatus, hypoglossal canal to the midline were measured bilaterally to compare both sides. Results: The foramen spinosum and the mid-clival line measurements demonstrated statistically significant results favoring the right side (p=0.03, right mean 3.052 ± 0.253 cm, left mean 2.982 ± 0.193 cm). In males, the right foramen spinosum to mid-clival line measurements were significantly longer than the left side (p=0.027, right mean 3.150 ± 0.250 cm, left mean 3.070 ± 0.180 cm). Conclusion: As predicted, the male measurements were significantly longer than the female measurements regardless of sides in all measurements. The measurements of cranial asymmetries may help describe anomalies and may contribute to the clinical approaches.

Axillary artery branching pattern variations are commonly observed during routine dissections. These variations have great importance due to the wide range of therapeutic and diagnostic procedures carried out in the axillary region. Therefore, neurovascular abnormalities should be well-known before surgeries involving the axillary region in order to prevent complications. This case report presents a common trunk at the third part of the axillary artery which gives rise to the deep brachial artery.

Abstract Purpose The aim of this study was to investigate the effects of early active movement on the area repaired with three different suture techniques used in extensor tendon injuries in zone IV. Materials and Methods A total of nine cadaver’s 35 extensor tendons from 9 intact upper extremities were used in this study. The proximal and distal borders of the extensor tendons in zone IV were marked. The distance between the proximal and distal border was measured with a 0.5 mm precision tape measure and the mid-point was marked. Intertendinous connections were dissected and loop sutures were prepared for each extensor digitorum. Afterwards, force was applied to each digit along the tendon axis from the loops inserted into the extensor tendons, to measure the extensor forces required to extend the MCP joints to 0˚ with a hand scale. The flexor tendons of the digits were dissected at zone III, and loop sutures were prepared individually for the tendons to enable independent flexion for each digit. The force required to fully flex the digits was measured with a hand scale. The extensor tendons were incised transversely and repaired at the mid-point in zone IV with three different suture techniques (double Kessler, double figure of eight, running interlocking horizontal mattress (RIHM)). The extenxor tendon lengths in zone IV were re-measured for all digits after suturing. The predetermined forces required for full flexion and extension of the digits were applied to the repaired digits. After force was applied 20 times to each tendon, the gap formation was checked. Totally 200 flexion and 200 extension movements were applied to each finger with the help of a hand-held scale. Formation of 2-mm gap was failure criteria. At the end of the movements the extent of the gaps was recorded. In the absence of insufficiency at the repair site, 50 additional flexion and extension movements with double the previously recorded forces were applied to the tendons. Results There was a significant shortening of the extensor tendons after repair independent from the used suture technique. No significant gap formation was detected in all three suture techniques. Conclusion All three suturing techniques are reliable for early active movements following the zone IV extensor tendon repairs. Therefore, surgeons can choose one of those three suture techniques to repair extensor tendon injuries in zone IV.

Objectives: Confirmation of the endotracheal tube placement (CoETP) has the utmost importance in the management of an airway. Visualization of tracheal rings or carina with a fiber-optical bronchoscope (FOB) has considered to be a reliable method for the CoETP. However, FOB is expensive, time-consuming, and not always practical. Inexpensive endoscopic USB-cameras were shown to aid intubation successfully and reliably. On the other hand, there have been no studies investigating their use for the CoETP. Tracheal ultrasonography (TUS) is also a new, inexpensive and widely available alternative. A cadaver study has planned to evaluate the diagnostic utility of TUS and a USB-camera. Methods: This study was conducted in the Anatomy Lab of a University on a fresh frozen female cadaver. Three senior Emergency Physicians have intubated the cadaver, and performed TUS or USB-endoscopy. We have prepared a randomized intubation list (n = 96) in three blocks (3 times 32) as to include equal number of esophageal and tracheal intubations (48 for each). Each EP is performed all three interventions (intubation, TUS and USB-endoscopy) in consecutive blocks of 32 intubations, in turn. The position of the tube has been verified from a 2 cm wide ostium on the proximal trachea. Results: In this study, all intubations (n = 96, 100%) were correctly identified as tracheal or esophageal with both TUS and USB-camera. Both the sensitivity and specificity of TUS and USB-endoscopy for the CoETP were 100.0%. Conclusion: The perfect accuracy of TUS and USB-endoscopy, have placed those techniques in a unique position as an alternative in resource-poor situations. (C) 2018 Elsevier Inc. All rights reserved.

Morphometric measurements of cranial nerves in posterior cranial fossa of fetus cadavers were carried out in an attempt to identify any asymmetry in their openings into the cranium. Twenty-two fetus cadavers (8 females, 14 males) with gestational age ranging between 22 and 38 weeks (mean 30 weeks) were included in this study. The calvaria were removed, the brains were lifted, and the cranial nerves were identified. The distance of each cranial nerve opening to midline and the distances between different cranial nerve openings were measured on the left and right side and compared. The mean clivus length and width were 21.2 ± 4.4 and 13.2 ± 1.5 mm, respectively. The distance of the twelfth cranial nerve opening from midline was shorter on the right side when compared with the left side (6.6 ± 1.1 versus 7.1 ± 0.8 mm, p = 0.038). Openings of other cranial nerves did not show such asymmetry with regard to their distance from midline, and the distances between different cranial nerves were similar on the left and right side. Cranial nerves at petroclival region seem to show minimal asymmetry in fetuses.

The septum is a basal forebrain region located between the lateral ventricles in rodents. It consists of lateral and medial divisions. Medial septal projections regulate hippocampal theta rhythm whereas lateral septal projections are involved in processes such as affective functions, memory formation, and behavioral responses. Gamma-aminobutyric acidergic neurons of the septal region possess the 65 and 67 isoforms of the enzyme glutamic acid decarboxylase. Although data on the glutamic acid decarboxylase isoform distribution in the septal region generally appears to indicate glutamic acid decarboxylase 67 dominance, different studies have given inconsistent results in this regard. The aim of this study was therefore to obtain information on the distributions of both of these glutamic acid decarboxylase isoforms in the septal region in transgenic mice. Two animal groups of glutamic acid decarboxylase–green fluorescent protein knock-in transgenic mice were utilized in the experiment. Brain sections from the region were taken for anti-green fluorescent protein immunohistochemistry in order to obtain estimated quantitative data on the number of gamma-aminobutyric acidergic neurons. Following the immunohistochemical procedures, the mean numbers of labeled cells in the lateral and medial septal nuclei were obtained for the two isoform groups. Statistical analysis yielded significant results which indicated that the 65 isoform of glutamic acid decarboxylase predominates in both lateral and medial septal nuclei (unpaired two-tailed t-test p < 0.0001 for LS, p < 0.01 for MS). This study is the first to reveal the dominance of glutamic acid decarboxylase isoform 65 in the septal region in glutamic acid decarboxylase–green fluorescent protein transgenic mice.

AIM:To evaluate the changes in the number of NADPH diaphorase (NADPH-d) stained neurons in the vagal nuclei in a chronic esophagitis model.MATERIALS AND METHODS:There were 3 groups of rats examined: 1) a chronic gastroesophageal reflux rat group, which was created by a partial gastric outlet obstruction; 2) a sham group; and 3) a ranitidine treated group. Serial sections ofbrainstems of all groups were cut and NADPH-d staining, which selectively stains the nitric acid synthase-containing neurons, was done.RESULTS:Histopathological changes due to chronic reflux esophagitis was observed in the reflux group. The ranitidine treatment and sham control groups showed no changes related to esophagitis. The staining in the dorsal motor nucleus of the vagus and nucleus tractus solitarius showed statistically significant differences compared to the control group (P < 0.0001).CONCLUSION:The increased nitric oxide expressions in the dorsal vagal nucleus and nucleus tractus solitarius are most probably due to adaptive changes to disturbed esophageal motility and mucosal damage.

BACKGROUND:The index finger to ring finger length ratio (2D:4D) of the right hand are affected by prenatal testosterone levels in male. To date, it has been determined that the high 2D:4D ratio is related to the myocardial infarction, however no research has revealed the relationship between the high 2D:4D ratio whose coronary artery shows atherosclerotic plaque development. OBJECTIVE:The aim of this study was to display the relationship between the 2D:4D ratio and atherosclerosis formation in male autopsy cases. METHODS:We designed a study in 100 heterosexual male autopsies whose mean age was 21.4+/-2.47 (range between 17 and 25). The 2nd and 4th digits were measured on the palmar surface of the right hand and taken the right coronary artery to show the atherosclerotic plaque development. RESULTS AND CONCLUSION:Grade 3 group had significantly higher 2D:4D ratio compared to Grade 1 and Grade 2 groups (p=0.02 for both).