A guide to facilitate the creation of a femoral tunnel for arthroscopic ligamentum teres reconstruction: a three-dimensional computed tomography study.

The ideal femoral tunnel passing through the centre of the femoral neck targeted to the footprint of the ligamentum teres (LT) is established during the LT reconstruction surgery with the free-hand technique. We aimed to quantitatively determine the entry site and define the angular orientation of the ideal femoral tunnel with its relevance to the femoral valgus angle (FVA) and the femoral anteversion angle (FAA) to facilitate the creation of an ideal femoral tunnel during the LT reconstruction surgery. A total of 60 randomly selected CT images were obtained to reconstruct three-dimensional femur models. A virtual reamer representing the ideal femoral tunnel was placed in the femur models. The femur length, FVA, FAA, the femoral tunnel anterior angle, the femoral tunnel superior angle and the skin- and bony-entry sites were measured. The femoral tunnel angular orientation was strongly correlated with the FVA and the FAA. Mathematical formulas were defined by which entry site of the reamer and the anterior and superior angulation of the femoral tunnel could be estimated before the surgery. The mean skin-entry site was 67.3 mm distal and 0.1 mm anterior to the centre of the greater trochanter's superior border. The angular orientation of the femoral tunnel using FVA and FAA can be easily estimated using mathematical formulas before LT reconstruction surgery. The entry site and angular orientation of the femoral tunnel described in this study can be used to reduce dependency on the usage of fluoroscopy and the workload on the surgeon during the LT reconstruction surgery.

Perpendicular drill bit alignment provides a practical guidance to determine the appropriate suture anchor insertion angle during acetabular labral repair.

The safe acetabular rim angle is an anatomical measurement used to determine the safety margin when inserting suture anchors. The purpose of the present study was to find out whether aligning the drill bit perpendicularly during arthroscopic surgery can provide a reference point for determining an appropriate angle to facilitate the suture anchor insertion and to prevent extra- and intra-articular perforations. One hundred computed tomographic hips were used to reconstruct three-dimensional acetabular hip models. Each model was radially sectioned at the 4 o'clock, 3 o'clock and anterior inferior iliac spine (AIIS) positions (that corresponded mainly to the 2:20 clock position). A perpendicular reference line, representing a perpendicular drill bit alignment, was drawn for each position within the acetabular model, and its relation to the safe acetabular rim angle was measured. The length of the perpendicular reference line and the effect of gender on measurements were also evaluated. The mean safe acetabular rim angle at the 3 o'clock position was significantly smaller compared to other clock positions (P < 0.001). The perpendicular reference line was located out of the safe acetabular rim angle in 28 cases (%28), mostly in female acetabula at the 3 o'clock position, and relative to the perpendicular reference line the required minimal angle was 4° ± 2.3° to place the anchor in the safe acetabular rim angle to avoid extra-articular perforation. The perpendicular reference line was shortest at the 3 o'clock position, and its mean length was shorter in female acetabula at all clock positions (P < 0.001). Aligning the drill bit perpendicular to the acetabular opening plane during an arthroscopic anchor placement is a practical way to estimate and target the position of the safe acetabular rim angle to avoid anchor perforations. Based on measurements from a perpendicularly aligned drill bit, the drill bit should be directed towards the joint minimally by 4° to avoid extra-articular perforations and maximally by 30° to avoid intra-articular perforations.

Morphometric characteristics of caudal cranial nerves at petroclival region in fetuses.

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.

An earplug technique to reduce the gag reflex during dental procedures.

BACKGROUND: The gag reflex is a frequent problem occurring during dental treatment procedures, especially while making impressions of the maxillary teeth. The present study aims to evaluate the efficacy of a simple earplug as an external auditory canal stimulator to supress the profound gag reflex and as a second step, to map areas of the oropharynx suppressed by this technique. METHODS: In the first step of the study, 90 patients who had a gag reflex during the impression procedure were allocated to a study group, a sham group, and a control group for evaluating the efficacy of the earplug technique. Second, 20 new patients with a gag reflex were included in order to map the oropharnygeal areas suppressed by this technique. RESULTS: The severity of the gag reflex was reduced in the earplug group (but not in the sham or the control group). The affected area included the hard palate, uvula, and the tongue but not the posterior wall of oropharynx. CONCLUSION: An earplug technique can be a useful, practical, and effective tool to overcome the gag reflex during oral procedures, such as impression procedures of maxillary teeth.

Myocardial bridges of the coronary arteries in the human fetal heart.

During the last century, many investigators reported on myocardial bridges in the adult human heart. In the present study, 39 human fetal hearts (the mean gestastional age was 30 weeks) were studied for myocardial bridging, and the results were correlated with adult data. Among the 39 (27 male and 12 female) fetal hearts studied, 26 bridges were observed on 18 fetal hearts (46.2%). Ten of the bridges had one myocardial bridge, whereas double myocardial bridges were observed in eight fetal hearts. The most frequent myocardial bridges were observed on the left anterior descending artery (LAD), which had 13 bridges (50%). Eight (30.7%) myocardial bridges were on the diagonal artery, and on the posterior descending artery there were five (19.3%). Myocardial bridges were not observed on the circumflex artery. The data presented in this study may provide potentially useful information for the preoperative evaluation of the newborn and may have a clinical implication for sudden fetal death.

The high 2D:4D finger length ratio effects on atherosclerotic plaque development.

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).

A preliminary study, using electron and light-microscopic methods, of axon numbers in the fornix in autopsies of patients with temporal lobe epilepsy.

Our objective was to show morphological changes of the fornix in autopsies of patients with temporal lobe epilepsy, which may potentially serve for post-mortem diagnosis. Epileptic and non-epileptic autopsy brains were obtained from the council of forensic medicine between the years 2005 and 2007. In both non-epileptic and epileptic autopsies the mean cross-sectional areas and fiber densities of the right and left fornices were calculated and analyzed. The numbers of myelinated and unmyelinated fibers, and the total number of fibers forming each fornix were counted. The total number of fibers in the right fornix was always greater than in the left fornix, in both epileptic and non-epileptic autopsies. The mean total number of fornix fibers was significantly reduced in epileptics compared with non-epileptics, in both the right (p = 0.043) and left (p = 0.043) sides. The electron-microscopic sections showed that myelinated axons outnumbered unmyelinated axons in both epileptic and non-epileptic autopsies. However, the reduction in the number of unmyelinated fibers was only statistically significant for the right fornix in right epileptic autopsies (p = 0.021). Although the reduction in the number of myelinated fibers was not statistically significant, electron-microscopic evaluations showed myelin degeneration of the myelinated fibers in the right fornix of the right temporal lobe in epileptic autopsies. In conclusion, our results suggest that unmyelinated fiber loss is functionally important, and may have functional consequences of diagnostic value.

Connections between the facial, vestibular and cochlear nerve bundles within the internal auditory canal.

The vestibular, cochlear and facial nerves have a common course in the internal auditory canal (IAC). In this study we investigated the average number of nerve fibres, the average cross-sectional areas of the nerves and nerve fibres, and the apparent connections between the facial, cochlear and vestibular nerve bundles within the IAC, using light and scanning electron microscopy. The anatomical localization of the nerves within the IAC was not straightforward. The general course showed that the nerves rotated anticlockwise in the right ear from the inner ear end towards the brainstem end and vice versa for the left ear. The average number of fibres forming vestibular, cochlear, and facial nerves was not constant during their courses within the IAC. The superior and the inferior vestibular nerves showed an increase in the number of nerve fibres from the inner ear end towards the brainstem end of the IAC, whereas the facial and the cochlear nerves showed a reduction in the number of fibres. This suggests that some of the superior and inferior vestibular nerve bundles may receive fibres from the facial and/or cochlear nerves. Scanning electron microscopic evaluations showed superior vestibular-facial and inferior vestibular-cochlear connections within the IAC, but no facial-cochlear connections were observed. Connections between the nerves of the IAC can explain the unexpected vestibular disturbances in facial paralysis or persistence of tinnitus after cochlear neurectomy in intractable tinnitus cases. The present study offers morphometric and scanning electron microscopic data on the fibre connections of the nerves of the IAC.

Drainage patterns of middle lobe vein of right lung: an anatomical study.

OBJECTIVE: The purpose of the present study was to determine the variations in the drainage patterns of middle lobe vein of the right lung. METHODS: Right lungs of 30 formalin fixed cadavers, were dissected carefully to expose the variations in the venous drainage of their middle lobes. After identifying the pulmonary veins for each lobe, middle lobe vein (MLV) drainage patterns were followed to their openings. The diameters of the MLV and its lateral and medial parts were measured with a caliper. The length of the MLV trunk was also evaluated. RESULTS: Five different types of venous drainage patterns were observed. Type-I: Union of medial and lateral parts to form MLV as a trunk and opening of this vein to the right superior pulmonary vein (RSPV) (53.3%). Type-II: Opening of medial and lateral parts to the RSPV separately (16.6%). Type-III: Union of medial and lateral parts to form the MLV trunk and opening of this vein into the left atrium (16.6%). Type-IV: Opening of medial and lateral parts into the left atrium separately (10%). Type-V: Union of medial and lateral parts to form MLV trunk and opening of this vein to the right inferior pulmonary vein (3.3%). CONCLUSION: The venous drainage patterns of right middle lobe reveals great number of variations. Knowing the frequency of different types of drainage patterns classified in this study is extremely important for the surgeons performing pulmonary surgery, atrial fibrillation and imaging techniques.

Unique case of trifurcation of the brachial artery: its clinical significance.

The variability of the arteries in the upper extremity is considerable. This case is a report of a trifurcation of the brachial artery that divided into radial, ulnar, and superior ulnar collateral arteries high in the arm; the length of the brachial artery was only 4.9 cm. Because the upper extremity is a frequent site of injury, various surgical and invasive procedures are performed in this region; consequently, it is of utmost importance to be aware of arterial variations. For some medical procedures, there may be an increased risk of complications because of variant vessels; however, for other procedures, they may be beneficial. In addition to presenting a detailed anatomic study of the case, the clinical significance of the variation has been addressed.

Unusual anatomic variation of palmar sensory branches of the ulnar nerve: a case report.

Variant sensory branches of the ulnar nerve were encountered during a routine dissection of the palmar aspects of a cadaver hand. The variant branches were distributed to the ulnar half of the index, ulnar half of the middle, and radial half of the ring fingers. The communicating branch between the superficial ulnar branch and the third common digital branch of the median nerve was absent. Distribution of the median nerve sensory branches was normal. The clinical significance of this variation is discussed.