In vitro study of the toxic and teratogenic effects of prednisolone, azathioprine and mycophenolate mofetile on embryological development of rats.

This study aimed to evaluate the effects of the glucocorticoid prednisolone, the mycophenolic acid prodrug, azathioprine, and the fungi fermentation end product, mycophenolate mofetile on the embryological development of rats. Nine day-old rat embryos were cultured in rat serum containing prednisolone at varying concentrations (5-30 µg/ml) for 48 h. The test groups were cultured separately in rat serum containing 0.3-10 µg/ml azathioprine and 1-10 µg/ml mycophenolate mofetile. Embryonic development parameter effects of both drugs in combination with prednisolone (20 µg/ml) were studied using morphological methods, with special attention given to the incidence of malformations. The genotoxic effects of agents evaluated with the TUNEL test revealed that prednisolone is not a cause of developmental toxicity. The maximum safe dose of prednisolone that could be used in combination with other immunosuppressive agents was determined to be 20 µg/ml. Azathioprine was found to be toxic and teratogenic for the rat embryos beginning at a dose of 1 µg/ml. Dose-dependent toxic and teratogenic effects of mycophenolate mofetile were detected at doses lower than normal clinical ones.

Classification and volumetric study of the sphenoid sinus on MDCT images.

PURPOSE: We aimed to determine the position and size of the sphenoid sinus (SS) in our study and compare the results of the measurements relative to age, gender, and the presence of pituitary adenoma using multidetector computerized tomography (MDCT). METHODS: We retrospectively evaluated the paranasal sinus computerized tomography (CT) images of 200 individuals (age range of all the individuals 4-84 years; 101 females, 99 males; age range of individuals with pituitary adenoma 15-63 years; 15 females, 9 males) with 24 pituitary adenomas. The shape of SS were identified and classified, volume were measured by MDCT also for individuals with pituitary adenoma. RESULTS: It was determined that the volume averages were significantly affected by the type of SS. Among all the individuals studied, the sellar type of SS was most frequently observed (41.5%), followed by the postsellar type (38.5%), and the least observed was the presellar type (9%). The volume of the SS is bigger in males than females although the volume is not affected by the presence of pituitary adenomas. The development of the SS continues until the age of nine. CONCLUSION: The morphology and morphometry of the SS show individual differences. These anatomic variations are important for decision making and application for surgical interventions (especially transsphenoidal surgery).

Reevaluation of Mandibular Morphometry According to Age, Gender, and Side.

AIM: This study aims to reevaluation the linear and angular measurements of mandibles with multidetector computed tomography (MDCT) that is a new method and used frequently in recent years. MATERIALS AND METHODS: The archived MDCT images of 100 adult patients (age range, 15-74 years) without mandibular operation and trauma history were evaluated retrospectively. Mandibular ramus heights, maximal mandibular length, mandibular symphysis height, mandibular angles, and mandibular foramen distance measurements were performed on MDCT images. All measurement parameters were analyzed by gender, age groups, and sides. RESULTS: Mandibular linear length measurements were higher in males than in females (P < 0.05). Only mandibular symphysis height was statistically significantly different in age groups (P < 0.05). The Angle 1 (gonial angle) was found to be significantly higher in females (P < 0.05). The Angle 3 (right condyle-gnathion-left condyle angle) was observed to be significantly higher in the 60+ age group (P < 0.05). The 3 of the mandibular foramen measurements (distance from the front edge, distance to gonion, and height of lingula) were found to be higher in males than in females (P < 0.05). There were no significant differences according to age groups in these measurements. The lengths of the mandibular canals were higher in males (44.72 mm) than in females (41.68 mm). There was no statistically significant difference was found between gender, age groups, and sides of mandibular canal length. CONCLUSION: The MDCT was found to be a reliable method for the detection of mandibular morphometry when compared with the results of other radiographic images studies.

Evaluation of the facet joints with magnetic resonance images in the patients with disc degeneration and spondylolisthesis.

PURPOSE: We aimed to research in detail the morphology of the facet orientation (FO) and tropism (FT) in degenerative diseases. METHOD: This study consisted of patients with disc degeneration (DD) and with lumbar spondylolisthesis (LS) as well as a control group without these two diseases. The group of patients with DD was separated by DD grades. Vertebral body and intervertebral discs' (IVDs) morphometric values, facet joint osteoarthritis (OA) grading, FO and FT were examined in all the groups. All measurements were applied to MRIs of 353 patients. RESULT: There was a significant difference in facet angle values between the groups at L4-L5 (FO: p = 0.001). There was a significant negative correlation between FO at L4-L5 and L4 vertebral body anterior posterior diameter and L5 mid-vertebral body height, in 353 patients (p = 0.003; p = 0.010). Facet joint OA grading scores were lower in the control group than in the disc degeneration patient (DDP) and LS groups (p < 0.05). Sagittal FO was seen with the increase of facet joint OA scores at L4-L5 in the control and DDP groups (control: p = 0.001; DDP: p = 0.40). CONCLUSION: Facet joints can show different orientation values in LS and DDP groups at L4-L5. The presence of FT is a risk factor for an LS patient at L4-L5. Sagittal FO is seen with vertebral slip at L5-S1. FO is affected by the morphometric changes of the vertebral body at L4-L5. Discussions in this regard need to be resolved through further research.

Investigation of developmental toxicity and teratogenicity of cyclosporine A, tacrolimus and their combinations with prednisolone.

In this study, it was aimed to investigate the toxic and teratogenic effects of cyclosporine A and tacrolimus and their combinations with prednisolone using an in vitro rat embryo culture technique. Cyclosporine A (4-40 µg/ml), tacrolimus (1-20 µg/ml) and combinations of these drugs with prednisolone (20 µg/ml) at different concentrations were tested. Cyclosporine A and its combination with prednisolone were determined to have toxic effects on embryonic growth after 10 µg/ml. When used alone, the lowest dose of tacrolimus had embryotoxic effects on the total morphological score and number of somites. It was determined that cyclosporine A caused hematoma at 4 µg/ml and higher doses, and tacrolimus especially at 20 µg/ml caused an open neural tube beside hematoma. It was observed that cyclosporine A at 40 µg/ml dose initiated apoptotic effects at a very low rate, prednisolone increased this effect, tacrolimus led to excessive apoptosis after 15 µg/ml, and this effect did not change with prednisolone supplement. We are of the opinion that the doses should be determined carefully when cyclosporine A and tacrolimus are required to be administered to pregnant women with prednisolone combination, as prednisolone increases the toxic effects of cyclosporine A, and increases teratogenic effects of tacrolimus.

Radiological classification of the infraorbital canal and correlation with variants of neighboring structures.

This study aims to classify the infraorbital canal according to its position related to the maxillary sinus as observed by axial CT. It is a retrospective, cross-sectional study. This study was performed in a tertiary referral center. In this study, axial and coronal CTs of 750 patients were examined and infraorbital canals and neighboring structures were evaluated. Infraorbital canals were then classified according to their positions in relation to the maxillary sinus as seen in axial sections. Morphologic variations of neighboring structures were also noted and their correlations with specific canal types were investigated. Three types of infraorbital canal configurations were identified according to the canal's relationship with the maxillary sinus: Type 1, the infraorbital canal was totally protruding into the maxillary sinus (12.3 %); Type 2, the infraorbital canal was located at the floor of the maxillary sinus or was partially protruding into the maxillary sinus (51.2 %); Type 3, the infraorbital canal was totally embedded in the maxillary corpus or was bulging on the external face of the maxillary sinus (36.4 %). Concurrence of maxillary sinus septa and infraorbital canal type-1 was found to be statistically significant on both sides (right side p = 0.00, left side p = 0.00). The study radiologically classified the infraorbital canal according to its position as related to the anterior wall of the maxillary sinus, and found that the type where the canal was totally protruding into the maxillary sinus (type-1) had a significant rate of 12.3 %. The rate of the protruded infraorbital canal was doubled with the presence of maxillary sinus septa (25 %).

The effect of the presence of the accessory maxillary ostium on the maxillary sinus.

This study was conducted to investigate the presence of the accessory maxillary ostium and its effects on the maxillary sinus, and the concurrent occurrence of morphological variations of neighboring anatomical structures. This study was performed in a tertiary referral center. This is a cross-sectional retrospective study that evaluated coronal CTs of patients to determine the frequency of the accessory maxillary ostium and investigated any simultaneous morphological variations in neighboring anatomical structures. The presence of the accessory maxillary ostium (AMO) plus any concurrent morphological variations of neighboring structures were investigated in 377 patients, with 754 sides. AMO was found to be present in 19.1 % (72/377) of the patients. A concurrent mucus retention cyst was found to be statistically significant on both sides (right side: p = 0.00, left side: p = 0.00), as well as mucosal thickening (right side: p = 0.00, left side: p = 0.00), and maxillary sinusitis (right side: p = 0.04, left side: p = 0.03). No other concurrent variations of statistical significance were detected in the neighboring structures. Our study demonstrated that with the presence of AMO, the likelihood of encountering a mucus retention cyst (48.6 %) had an approximately threefold increase, and that of encountering mucosal thickening (43.0 %) and maxillary sinusitis (29.1 %) had a twofold increase.

Definition of an Effective Site for Greater and Third Occipital Nerve Block in the Nuchal Region: A Fetal Cadaver Study.

AIM: To determine the localization of the greater occipital nerve and the third occipital nerve according to palpable bone landmarks and their relationship with muscles in the suboccipital region and to define an effective zone for clinical approaches. MATERIAL AND METHODS: This study was conducted on 15 fetal cadavers. Bone landmarks to be used as reference were determined by palpation, and measurements were taken before dissection. The location, relationship and variation of these nerves and muscles (trapezius, semispinalis capitis, obliquus capitis inferior) were noted. RESULTS: It was detected that the nape triangular area formed between the reference points was scalene in males and isosceles in females. It was found that greater occipital nerve pierced aponeurosis of trapezius and passed under obliquus capitis inferior in all fetal cadavers and 96.7% of them had pierced semispinalis capitis. It was determined that the greater and third occipital nerve pierced the trapezius aponeurosis approximately 2 cm below the reference line and 0.5-1 cm lateral to the midline. CONCLUSION: One of the important factors for the high success rate in suboccipital invasive procedures in the pediatric population is to know the location of the nerves in the region correctly. We believe that the results of this study will contribute to the literature.

Accessory spleens at autopsy.

Accessory spleens (AS) may be formed during embryonic development when some of the cells from the developing spleen are deposited along the path from the midline, where the spleen forms, over to its final location on the left side of the abdomen. An accessory spleen is usually near the spleen's hilum, but it may be embedded partly or wholly in the tail of the pancreas. The aim of this study was to investigate the incidence and distribution of AS during routine forensic autopsies. AS were investigated in 720 consecutive autopsy cases. Fifty-four AS were found in 48 (6.7%) cases. AS were found in hilum of the main spleen in 28 cases, the great omentum in 13 cases, the pancreas in 5 cases, and the pelvis in 2 cases. There were two AS in two cases and three AS in another two cases. Awareness of the possible presence of AS is important because when splenectomy is performed for some conditions such as immune thrombocytopenic purpura, failure to remove the AS may result in the failure of the condition to resolve. Additionally, during medical imaging, AS may be confused for enlarged lymph nodes or neoplastic growths. In conclusion, autopsy series are useful for determining the incidences and the other features of AS in different populations, in addition to those studies using CT scans and those studies obtained during laparoscopic or open surgeries.

Communications between the palmar digital branches of the median and ulnar nerves: A study in human fetuses and a review of the literature.

In this study, median nerves (MNs) and ulnar nerves (UNs) were dissected in 200 palmar sides of hands (left and right) of 100 (50 male, 50 female) spontaneously aborted fetuses with no detectable malformations. The fetuses, whose gestational ages ranged from 13 to 40 weeks, were dissected under an operating microscope. The MN divided first into a lateral ramus and a medial ramus and then formed a common digital nerve. The first common digital nerve trifurcated in all of the studied cases. The branching patterns were classified into two types (Type 1 and Type 2) based on the relationship with the flexor retinaculum (behind/distal of it). A communication branch between the UNs and MNs in the palmar surface of the hand was found in 59 hands (29.5%). The proper palmar digital nerves were numbered from p1 to p10, starting from the radial half of the thumb to the ulnar half of the little finger, and these nerves exhibited six types of variations. The present data obtained from human fetuses will aid in elucidating the developmental anatomy of the nervous system and provide hand surgeons with a more complete anatomical picture to help them to avoid iatrogenic injuries.

The motor branches of median and ulnar nerves that innervate superficial flexor muscles: a study in human fetuses.

PURPOSE: We aimed to describe the distribution of the motor branches of the median and ulnar nerves that innervate the superficial flexor muscles in detail, as well as to determine any communication between these two nerves in a series of 100 human fetuses. METHODS: This study was performed on 200 upper limbs from 100 fetuses. However, the motor branches of the median nerve were determined on 50 upper limbs because of the developmental properties of medial epicondylar muscles. RESULTS: The motor branch, which innervates the pronator teres, is classified into two types and four subtypes. The flexor carpi radialis branch arose as a single branch in 30% of the cases. The innervation of the flexor digitorum superficialis was also performed by a single muscular branch in 88% of the cases and by two branches in 12% of the cases. The ulnar nerve was classified into two types according to the number of muscular branches in the forearm. Martin-Gruber anastomosis was observed in 7.5% of the cases. CONCLUSIONS: These results show differences from classical definitions regarding the muscular branching patterns of the median and ulnar nerves. We suggest revisiting the classical descriptions of innervation patterns of pronator teres, palmaris longus and flexor carpi radialis muscles, since the variations observed in their innervation patterns are more diverse than has been described.

Investigation and review of myocardial bridges in adult cadaver hearts and angiographs.

PURPOSE: We aimed to compare the myocardial bridges (MBs) both in the coronary angiography and cadavers. METHODS: Morphological (length, thickness, deepness, the angle between the long axis of vessel and location) and angiographic properties (length, degree of systolic obstruction, frequency) of the MBs were evaluated in 50 adult cadaver hearts and in 1,321 cineangiograms. RESULTS: Myocardial bridges were observed in 32 of the cadaver hearts (64%) and 100 of cineangiograms (7.57%). It was observed that MBs caused significant coronary stenosis in 34 of 100 individuals leading to the prevalence of significant MB to be (2.5%) in angiography. The MBs that are above the left anterior descending artery in cadaver were classified as superficial MB (77.4%) and deep MB (22.6%). In cineangiogram, the average length of MB (MBL) was determined as 10.32 +/- 4.62 mm. CONCLUSION: The presence of MB, MBL and degree of luminal narrowing were not associated with the age and gender. Deepness and thickness were a major determinant of significancy of systolic obstruction by MBs.

The course and variations of the branches of the musculocutaneous nerve in human fetuses.

The course and branches of the musculocutaneous nerve (MCN) were dissected in 140 human fetal arms. The MCN entered the superior, middle, and inferior part of coracobrachialis in 43%, 37%, and 17% of arms, respectively, and the remaining 3% did not pierce coracobrachialis. The motor branches to biceps were classified as follows: Type 1 (83.6%): a single branch that bifurcated to supply the two heads of biceps; Type 2 (14.3%): two separate branches each innervating one head of biceps; Type 3 (2.1%): a single branch that bifurcated to supply each head of biceps plus an additional branch that innervated the distal part of biceps. The motor branches to brachialis were classified as follows: Type 1 (93.6%): a single branch to brachialis; Type 2 (6.4%): a single branch that bifurcated into two branches both supplying brachialis. Communications between the MCN and the median nerve (MN) were observed in 10% of specimens, of which three types (A, B, C) could be identified depending on their origin and union. In the most frequently observed type (B, 50% of cases) the communicating branch arose from the proximal part of the MCN and joined the MN in the middle or distal part of arm. The data presented here will be of use to surgeons, especially pediatric surgeons who undertake surgical procedures in the axilla and arm.

Mental foramen and lingual vascular canals of mandible on MDCT images: anatomical study and review of the literature.

The mental foramen and lingual vascular canals are related to vessels and nerves in the mandibular body. The aim of the present study was to determine the number and location of these structures and to make measurements of them. The archived Multidetector Computed Tomography images of 100 adult (15- to 70-year-old) patients were evaluated retrospectively. The diameters of the mental foramens and their distances from the front, back, upper and lower reference points were measured. The distribution of mental foramens with respect to the teeth was also researched. The presence of lingual vascular canals, and the number of median and lateral canals was determined, and the length of the median lingual vascular canals measured. All measurement parameters were analyzed by gender, side and age group. Eleven patients demonstrated a total of 15 accessory mental foramen. Median lingual vascular canals were observed in 100% of cases, with lateral lingual vascular canals determined in 32%. Significant differences were observed in the results of different gender groups (P < 0.05); in contrast, no significant difference was observed related with age or side. Accessory mental foramen was determined mostly in males, and unilaterally on the right side; also, the distances of mental foramen, except the distance from the back border of the mandible (P < 0.05), were found to be higher, bilaterally, in males. Variation of mental foramen, as well as the presence, position and size of lingual vascular canals can be clearly investigated by multidetector computed tomography. A preoperative knowledge of the positions of neurovascular and bone structures is very important for preventing complications that may occur during or after operations.

Prevalence of pneumatized uncinate process and accompanying neighboring variations.

OBJECTIVES: This study aims to investigate the prevalence of uncinate process (UP) pneumatization and also to investigate the association of UP pneumatization with concurrent morphological variations in neighboring structures and the presence of maxillary sinusitis. PATIENTS AND METHODS: This was a retrospective study where coronal computed tomography scans of 1,500 UPs in 750 patients (483 males, 267 females; mean age 36.3±14.7 years; range 7 to 84 years) were examined to determine the prevalence of UP pneumatization and to assess any concurrent neighboring anatomical structures and the presence of maxillary sinusitis between January 2013 and June 2013. RESULTS: Uncinate process pneumatization was identified in a total of 6.26% of our patients with 1.60% being bilateral, 2.53% on the right only, and 2.13% on the left side only. Other than concurrent occurrences of right maxillary sinus septa (p=0.046), growth of the right ethmoidal bulla (p=0.044) and presence of maxillary sinusitis (right side: p=0.046, left side: p=0.035) were seen. CONCLUSION: We detected a 6.2% prevalence of UP pneumatization in our study group. An abnormally sized and over-pneumatized UP can cause narrowing of the infundibulum and impaired sinus drainage. Such functional blockage can lead to recurrent maxillary sinusitis, stuffiness, and decreased olfaction.

A rare variation of the coeliac trunk.

The hepatic, splenic and Left gastric arteries are considered as the "main classic branches" of the coeliac trunk. During the routine dissections in the laboratory of the Anatomy Department in a 62-year-old male cadaver, a rare variation, a coeliacomesenteric trunk was observed. This trunk gave rise to the left gastric, the common hepatic, the splenic, the left gastro-epiploic, the right and left inferior phrenic arteries. The developmental and clinical significance of this anomalous vessel is discussed.

MAJOR ANATOMIC VARIATIONS OF PULMONARY FISSURES AND LOBES ON POSTMORTEM EXAMINATION.

This study was aimed at determining major accessory fissures (MAF) and absence or incompleteness of lobar or major fissures (MF) during routine forensic autopsies. Prior to starting this prospective study, forms were prepared to collect data on pulmonary lobes and fissures. In this study, 420 lungs of 210 autopsy cases were examined for incompleteness and absence of MF and complete accessory fissures. Horizontal fissures were incomplete in 18 right lungs. Incomplete oblique fissures were noted in three right and two left lungs. Unidentified abnormal fissures were determined in one left lung and five right lungs. The most common fissural abnormality was less than half complete horizontal fissure. Four right lungs had four lobes and two left lungs had three lobes because of complete accessory fissures. The number of lobes in the left and right lungs and the morphological features of both incomplete MF and MAF were determined in detail and the variations were photographed. It is concluded that, in addition to studies on computed tomography scans, autopsy series are useful for determining the variations of MF and MAF of the lungs in different populations.

Brachial plexus variations in human fetuses.

OBJECTIVE: We examined the anatomic variations of the brachial plexus (BP) in human fetuses. METHODS: This study was performed with 200 BPs from spontaneously aborted fetuses without detectable malformations. The plexuses were dissected, and the normal position and/or morphological variations of the BP were determined and photographed. RESULTS: There were no variations in 93 plexuses, and 107 plexuses were observed to have different variations. Morphological variations were observed more frequently among female fetuses and right sides. The BPs were composed mostly of the C5, C6, C7, and C8 nerves and the T1 nerve (71.5%). A prefixed plexus was observed in 25.5% of cases, and a postfixed plexus was observed in 2.5% of cases. In one case (0.5%), the C4 and T2 nerves joined the formation. The inferior trunk was not formed in 9% of cases. The superior trunk was not formed in 1% of cases. In one plexus, the superior trunk was formed by the ventral rami of the C4 and C5 nerves. In one case, the inferior trunk was formed by the ventral rami of the T1 and T2 nerves. Division variations were observed most frequently. There were also variations in the terminal branches, such as the roots of the median nerve joining in the distal part of the arm (8.5%), the axillary nerve being separate from the posterior division of the superior trunk (2.5%), and a connection existing between the median and musculocutaneous nerves (1%). CONCLUSION: Knowledge of BP variations is important for surgeons who perform surgical procedures in the cervical and axillary regions.

Possibility of middle meningeal artery-to-petrous internal carotid artery bypass: an anatomic study.

The possibility of creating a middle meningeal artery (MMA)-to-petrous internal carotid artery (ICA) bypass was investigated in six cadavers (bilaterally). Such a procedure could be used to treat patients with high cervical vascular lesions and those with tumors of the infratemporal fossa invading the high cervical ICA. After a frontotemporal craniotomy, the foramen spinosum and foramen ovale were exposed extradurally. Immediately posterior to the foramen ovale and medial to the foramen spinosum, the petrous portion of the ICA was exposed with a diamond-tipped drill. The MMA was lifted from its groove, and a sufficient length was transected to perform a bypass with the petrous ICA medially. The mean width of the MMA at the site of anastomosis was 2.3 +/- 0.35 mm. The mean length of MMA from the foramen spinosum to the site of the anastomosis was 9.6 +/- 1.7 mm. Based on these measurements, width and length of MMA appear to be sufficient for a bypass with petrous ICA.

Is the rabbit knee a suitable model for the human interphalangeal and metacarphophalangeal joints of the hand?

OBJECTIVES: The purpose of this study was to assess the suitability of the rabbit knee as a small joint model for the human interphalangeal and metacarphophalangeal joints of the hand. METHODS: The proximal joint surface areas of 47 middle phalanges, the proximal and distal joint surface areas of 90 proximal phalanges, and the distal joint surface areas of 42 metacarpals of various human cadavers were calculated and compared with the distal femoral and proximal tibial joint surface areas of 20 knee of 10 New Zealand white rabbits by a photogrammetric method. RESULTS: The mean joint surface area of the rabbit proximal tibia was larger than the proximal joint surface area of the middle phalanx, the distal joint surface area of the proximal phalanx, the proximal joint surface area of the proximal phalanx, and the distal joint surface area of the metacarpal. The mean joint surface area of the rabbit distal femur was larger than that of the middle phalanx, but similar to the proximal joint surface area of the proximal phalanx, and that of the distal metacarpal and distal proximal phalanx. CONCLUSION: The rabbit knee is not suitable model for the human interphalangeal and metacarphophalangeal joints of the hand. There is still a lack of an appropriate animal model for the small joints of the hand.