Detailed Surgical Anatomy of Prostate: Relationship between Urethra and Dorsal Vein Complex with Apex.

AIM: To describe our surgical technique for dissecting the apex of prostate during robotic-assisted laparoscopic radical prostatectomy (RALP) and detailed surgical anatomy of prostate including relationship between urethra and dorsal vein complex with apex. MATERIALS AND METHODS: In retrospective view of prospective collected data, 73 patients underwent RALP between December 2012 and September 2014. Surgical anatomy of prostate was revealed in all procedures. Quality of life (QoL) scores were assessed before, immediately after catheter removal, and 1 month after surgery. We divided urinary continence into 3 groups, as very early continence; continence at time of urethral catheter removal, early continent; and continence 1 month after surgery. The rest of the patients were accepted as continence. RESULTS: The mean follow-up was 10.2 ± 5.4 months and mean age was 61.5 ± 6.6. Maximum protection of urethra could be provided in all. Mean catheter removal was 8.9 ± 1.7 days, and all patients were continent at the time of catheter removal. QoL scores before RALP could be protected after surgery (p = 0.2). Neither conversion to open/conventional laparoscopic surgery nor complications related with bladder neck were detected. CONCLUSIONS: Our surgical technique can be a strong candidate for being a surgical technique for preserving urethra and very early continence could be provided after surgery.

Evaluation of the Trachea and Bronchi in COVID-19 Patients Using the 3-dimensional Reconstruction Method.

OBJECTIVE: To evaluate changes in the trachea and bronchi of COVID-19 patients using the 3-dimensional reconstruction images obtained from chest CT (computed tomography) scans. STUDY DESIGN: An observational study. Place and Duration of the Study: Departments of Anatomy and Radiology, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey, between March 2021 and January 2022. METHODOLOGY: There were 150 COVID-19 patients in the acute period and 150 individuals as the control group. The CT images were transferred to Mimics software, and a 3-dimensional reconstruction was performed. COVID-19 patients were grouped separately by gender, and their total lung severity score was classified as absent (Grade 0), mild (Grade 1), moderate (Grade 2), and severe (Grade 3). RESULTS: The cross-sectional area and diameter of the right upper lobar bronchus decreased as the grade increased (p<0.05 and p<0.001, respectively). The circumference of the right upper lobar bronchus and the cross-sectional area and circumference of the left lower lobar bronchus were found to be narrower in Grade 1-2-3 COVID-19 patients compared to those of the control group (p<0.01, p<0.05, and p<0.05, respectively). The cross-sectional area, circumference, and diameter of the middle lobar bronchus were found to be narrower in Grade 3 COVID-19 patients (p<0.05, p<0.05, and p<0.05, respectively). CONCLUSION: Although mostly independent of the grade increase, narrowing of the trachea and bronchi was observed in COVID-19 patients in the acute period. Further research is required with to reveal whether the narrowings are permanent. KEY WORDS: COVID-19, Trachea, Bronchus, 3-dimensional reconstruction.

The long-term effects of progesterone-only contraceptives on endometrium and ovary in rats.

Progestin-only (p-only) contraceptives often cause breakthrough bleeding for unknown reasons. In this study, we aimed to evaluate the long-term effects of p-only contraceptives to gain a better understanding of breakthrough bleeding mechanism. Wistar rats were divided into etonorgesterel implant (Group 1, n = 25), depot medroxyprogesterone acetate injectable (Group 2, n = 25), and control groups (n = 5). Five rats each from groups 1 and 2 were examined every 10 days for up to 50 days after the medication. Uteri and ovaries were removed and prepared for immunohistochemistry and scanning electron microscopy. The tissue nitric oxide (NO) levels were determined by Griess reaction. Dynamic changes of endometrial estrogen and progesterone receptor immunoreactivity were observed in a time-dependent manner in groups 1 and 2. The number of endometrial pinopodes, which are small endometrial protrusions, increased in both groups. There was no difference between groups for the estrogen receptor in the surface epithelium of the ovary. Estrogen-alpha and progesterone receptor in follicular cells decreased in a time-dependent manner. The granulosa cells underwent atrophic and were disorganized. Decreased levels of uterine tissue NO were determined in groups 1 and 2. The effect of some p-only contraceptives make some dynamic changes in the endometrium, ovaries, steroid hormone receptors, cell morphology, and biochemical features of the tissues during their use.

The effects of melatonin on possible damage that will occur on adipocytokines and liver tissue by coadministration of fructose and bisphenol a (BPA).

BPA, one of the environmental endocrine disruptors, and fructose, reason of liver steatosis which is frequently encountered in the daily diet, contribute to the formation of metabolic syndrome (MetS). This study examines the possible effects of concurrent fructose and BPA administration on MetS and determines the effects of melatonin on this process. In the seven identified groups, a total of forty-two adult male Sprague Dawley rats were treated by following fructose, BPA, and melatonin amounts, separately and together: group 1 (control), group 2 (10% aqueous fructose), group 3 (25 mg/kg BPA), group 4 (10% fructose + 25 mg/kg BPA), group 5 (10% fructose + 20 mg/kg melatonin), group 6 (25 mg/kg BPA + 20 mg/kg melatonin), and group 7 (10% fructose + 25 mg/kg BPA + 20 mg/kg melatonin). At the end of 60 days, histochemical, immunohistochemical, and biochemical procedures were performed on liver tissue. As a result, it was seen that BPA and fructose + BPA induced morphological alteration and inflammation and increased intracellular lipid quantity and amount of collagen and reticular fibers. The percentage of apoptotic liver cells stained by annexin V-FITC/PI was lower in group 7 compared to the group 4 (p < 0,001) and also in group 6 compared to the group 3 (p = 0.014). Both BPA and fructose application caused an increase in lipid peroxidation level due to the increase of oxidative stress. Application of melatonin induced antioxidant enzyme activity and reduced lipid peroxidation level. Our results indicate that fructose and BPA administration triggered the formation of MetS, whereas melatonin healed these variations, although not entirely.

High-dose vitamin C supplementation accelerates the Achilles tendon healing in healthy rats.

INTRODUCTION: This experimental study was performed to assess, whether or not, vitamin C, required during the collagen synthesis, would influence the Achilles tendon healing in a healthy rat model. MATERIALS AND METHODS: The right Achilles tendons of 42 healthy female Wistar Albino rats were completely ruptured. The rats were randomly divided into the vitamin C and control groups and both groups included third, tenth and twenty-first day subgroups. One hundred and fifty milligrams (1.5 cc) of vitamin C and 1.5 cc % 0.9 NaCl were injected once for every 2 days for the vitamin C and control groups, respectively. Qualitative and quantitative microscopic comparisons of the repair tissues of both groups were made on the mentioned days. RESULTS: Angiogenesis was more evident on the third day in the vitamin C group. There was a significant difference between the control and vitamin C groups regarding the type I collagen production on the tenth day. The structure of the repair tissue was almost in the form of regular dense connective tissue at the end of twenty-first day in the vitamin C group. Mean collagen fiber diameter was considerably higher, and the number of active fibroblasts in the repair tissue was slightly elevated in the vitamin C group during the entire healing process. CONCLUSION: High-dose vitamin C supplementation once for every 2 days has stimulating effects on the Achilles tendon healing because of early angiogenesis and increased collagen synthesis in a healthy rat model. Further studies are needed to make clear the mentioned encouraging effects of the vitamin C on the Achilles tendon healing.

Anatomical, radiological and histological investigation of the great and small saphenous veins.

OBJECTIVE: To provide information on superficial veins of the lower limb such as anatomic variations, valve distribution, termination forms, and histological properties of vein walls. METHODS: Two hundred greater saphenous veins in 200 patients and 10 cadavers were investigated. Ultrasound examinations were performed in the Department of Radiology, Ataturk Hospital between December 2004 and October 2005. RESULTS: The lateral accessory branch of the great saphenous vein was found in 75 persons while in 48 persons no major branch was encountered. In addition, medial accessory branch of the great saphenous vein was observed in 17 (8.5%) on both sides. The popliteal type of termination was found in 211 cases. The small saphenous vein gave off perforating branches to the popliteal vein in 29 persons. The diameters of such veins were all measured on both sides of the cadavers and ultrasonographically on patients. Statistical analyses revealed no significant difference. One hundred and fifty-six valves were classified according to their position and type. The maximum number of valves was found in the first interval and the minimum number was in the second interval. The valves were mostly in Type III format. CONCLUSION: Knowledge on the anatomic variations and characteristics of the valves of the superficial veins of the lower limbs can be helpful in clinical practice and surgical operations concerning the lower extremity.

Comparative evaluation of various low-level laser therapies on bone healing following tooth extraction: An experimental animal study.

PURPOSE: The aim of this study was to evaluate the effects of helium-neon and gallium-aluminum-arsenide lasers with various doses on bone healing following tooth extraction. MATERIALS AND METHODS: Maxillary right incisor teeth of 30 female albino Wistar rats were extracted. Five groups were established: four groups treated with helium-neon or gallium-aluminum-arsenide lasers and a control group. Both laser groups' rats received energy doses of 6 J/cm2 and 10 J/cm2 for 7 days. At the end of 30 days, all subjects were sacrificed for histological and morphological evaluations. RESULTS: Laser groups showed faster bone healing and gallium-aluminum-arsenide lasers increased vascular immunoreactivity. The most widespread organized bone formation in the extraction socket was observed in the gallium-aluminum-arsenide laser group with the energy dose of 10 J/cm2 (p < 0.05). CONCLUSION: This study demonstrated that low-level laser therapies were effective on alveolar bone healing and that an energy dose of 10 J/cm2 did not have an inhibition effect on bone regeneration.

Evaluation of angles of the tracheobronchial tree with the 3-dimensional reconstruction method: a morphometric and radiologic study / Evaluación de los ángulos del árbol traqueobronquial con el método de reconstrucción tridimensional: un estudio morfométrico y radiológico

SUMMARY: The objective of the current research is to assess the branching angles of the tracheobronchial tree and the correlation between these angles and the lung volume using the 3-dimensional reconstruction method. Thorax CT (computed tomography) images of 150 individuals, who were over 18 years of age and did not have any pathology on CT, were obtained retrospectively. A 3-dimensional reconstruction of the trachea, bronchi, and lungs was carried out. External and internal angles between the trachea and main bronchi, between the main bronchi and lobar bronchi, and between the lobar bronchi were measured. The volume measurement of the right and left lungs was performed. The individuals included in the study were grouped by sex and age (20-40 years, 41-61 years, and 62-87 years). The left subcarinal angle (LSA), total subcarinal angle (TSA), and left interbronchial angle (LIA) were found to be greater in the 62-87 age group. Both the external angle (LULB-LMBE) and the internal angle (LULB- LMBI) between the left upper lobar bronchus and the left main bronchus were observed to be greater in males. In males, a statistically significant negative moderate correlation was identified between the right lung volume and the right subcarinal angle (RSA). In females, a statistically significant positive moderate correlation was revealed between the external (RULB-IBE) and internal angles (RULB-IBI) between the right upper lobar bronchus and the intermediate bronchus, and the right lung volume. In the literature review we performed, we did not find any studies investigating the correlation between the branching angles of the tracheobronchial tree and the lung volume using the 3-dimensional reconstruction method. Therefore, we are of the opinion that our study will contribute to the literature.

El objetivo de la investigación fue evaluar los ángulos de ramificación del árbol traqueobronquial y la correlación entre estos ángulos y el volumen pulmonar utilizando el método de reconstrucción tridimensional. Se obtuvieron retrospectivamente imágenes de tomografía computarizada de tórax de 150 individuos mayores de 18 años sin patología. Se realizó una reconstrucción tridimensional de la tráquea, los bronquios y los pulmones. Se midieron los ángulos externo e interno entre la tráquea y los bronquios principales, entre los bronquios principales y los bronquios lobares, y entre los bronquios lobares. Se realizó la medición del volumen de los pulmones derecho e izquierdo. Los individuos incluidos en el estudio fueron agrupados por sexo y edad (20-40 años, 41-61 años y 62-87 años). Se encontró que el ángulo subcarinal izquierdo, el ángulo subcarinal total y el ángulo interbronquial izquierdo eran mayores en el grupo de edad de 62 a 87 años. Tanto el ángulo externo (LULB-LMBE) como el ángulo interno (LULB-LMBI) entre el bronquio lobular superior izquierdo y el bronquio principal izquierdo era mayor en los hombres. En los hombres, se identificó una correlación moderada negativa estadísticamente significativa entre el volumen pulmonar derecho y el ángulo subcarinal derecho. En mujeres, se reveló una correlación positiva moderada estadísticamente significativa entre los ángulos externos (RULB-IBE) e internos (RULB-IBI) entre el bronquio lobar superior derecho y el bronquio intermedio, y el volumen pulmonar derecho. En la revisión bibliográfica que realizamos, no encontramos ningún estudio que analizara la correlación entre los ángulos de ramificación del árbol traqueobronquial y el volumen pulmonar utilizando el método de reconstrucción tridimensional. Por lo tanto, consideramos que nuestro estudio contribuirá a la literatura especializada del tema.

Morphometric examination of the trachea and bronchi in follow-up computed tomography scans of COVID-19 patients / Examen morfométrico de la tráquea y los bronquios en tomografías computarizadas de seguimiento de pacientes con COVID-19

SUMMARY: The purpose of this study is to evaluate changes in the trachea and bronchi using 3-dimensional reconstruction images obtained from the initial and follow-up computed tomography (CT) scans of COVID-19 patients. A hundred COVID-19 patients over the age of 18 were included in our study. CT images were transferred to Mimics software, and a 3-dimensional reconstruction of the trachea and bronchi was performed. The initial and follow-up CT images of COVID-19 patients were graded as none (grade 0), mild (grade 1), moderate (grade 2), and severe (grade 3) according to the total lung severity score. The patients were divided into progression and regression groups according to the grade increase/decrease between the initial and follow-up CTs. Moreover, the patients were divided into groups as 0-2 weeks, 2-4 weeks, 4-12 weeks, and over 12 weeks according to the duration between the initial and follow-up CTs. The mean cross-sectional area, circumference, and diameter measurements of the right upper lobar bronchus, intermediate bronchus, middle lobar bronchus, and left lower lobar bronchus decreased in the follow-up CTs of the progression group. This decrease was not found to be statistically significant. In the follow-up CTs of the regression group, the left upper lobar bronchus and left lower lobar bronchus measurements increased but not statistically significant. Upon comparing the onset of the disease and the follow-up period, statistically significant changes did not occur in the trachea, main bronchus, and lobar bronchus of COVID-19 patients.

El propósito de este estudio fue evaluar los cambios en la tráquea y los bronquios utilizando imágenes de reconstrucción tridimensionales obtenidas de las tomografías computarizadas (TC) iniciales y de seguimiento de pacientes con COVID-19. En nuestro estudio se incluyeron 100 pacientes con COVID-19 mayores de 18 años. Las imágenes de TC se transfirieron al software Mimics y se realizó una reconstrucción tridimensional de la tráquea y los bronquios. Las imágenes de TC iniciales y de seguimiento de los pacientes con COVID-19 se calificaron como ninguna (grado 0), leve (grado 1), moderada (grado 2) y grave (grado 3) según la puntuación total de gravedad pulmonar. Los pacientes se dividieron en grupos de progresión y regresión según el aumento/disminución del grado entre las TC iniciales y de seguimiento. Además, los pacientes se dividieron en grupos de 0 a 2 semanas, de 2 a 4 semanas, de 4 a 12 semanas y de más de 12 semanas según la duración entre la TC inicial y la de seguimiento. Las mediciones medias del área transversal, la circunferencia y el diámetro del bronquio lobar superior derecho, el bronquio intermedio, el bronquio lobar medio y el bronquio lobar inferior izquierdo disminuyeron en las TC de seguimiento del grupo de progresión. No se encontró que esta disminución fuera estadísticamente significativa. En las TC de seguimiento del grupo de regresión, las mediciones del bronquio lobar superior izquierdo y del bronquio lobar inferior izquierdo aumentaron pero no fueron estadísticamente significativas. Al comparar el inicio de la enfermedad y el período de seguimiento, no ocurrieron cambios estadísticamente significativos en la tráquea, el bronquio principal y el bronquio lobar de los pacientes con COVID-19.

Numerical variation of the celiac trunk and anatomical variation in origin and course of the dorsal pancreatic artery.

A numerical anomaly of the celiac trunk and anatomical variation in origin, and course of the dorsal pancreatic artery were encountered during a routine upper abdomen dissection of a 62-year-old male cadaver. The aim of this study was to describe a rare celiac trunk and dorsal pancreatic artery variation in detail, which can be a guide and precaution during operative procedures in this region. The abdominal aorta, its branches and the pancreas were cut and removed just above the celiac trunk and below the superior mesenteric artery to investigate the vascular distribution of the pancreas in detail. The celiac trunk divided into the left gastric, hepatic, splenic, and dorsal pancreatic arteries. The anatomical variation of the celiac trunk and splenic artery makes it vulnerable to iatrogenic surgery. Knowledge of the existing aberrations is important in planning and conducting surgical procedures.

Effects of kinesiologic taping on epidermal-dermal distance, pain, edema and inflammation after experimentally induced soft tissue trauma.

PURPOSE: In sports medicine, the use of kinesiologic tape has recently gained popularity. Although widely used, there is no study examining the effects of kinesiologic tape on soft tissue after a contusion injury. The aim of this study was to examine the effects of kinesiologic taping on epidermal-dermal distance, edema, pain and inflammation after experimentally induced contusion injury. METHODS: Twelve adult female Wistar albino rats were divided into two groups: (1) 30 min group: n = 6, weight range: 182.0-199.4 g; and (2) 6 h group: n = 6, weight range: 186.9-200.8 g. After soft-tissue trauma, tape was applied to the right sides of each rat. In one group, tape was applied for 30 min while 6 h in the other. To assess the epidermal-dermal distance and edematous area, tissue sections were stained with hematoxylin and eosin and examined. Tissue sections were stained with nerve growth factor (NGF) and B-cell lymphoma 2 (Bcl-2) immunohistochemically to evaluate the effect of taping on pain and inflammation respectively. RESULTS: Epidermal-dermal distances were found to be significantly higher than controls' in both groups (p < 0.05). Notable decreases were seen in edematous areas in both groups (p < 0.05). NGF and Bcl-2 immune reactivity were decreased in all tape applied sides. CONCLUSIONS: After soft-tissue trauma, it was histologically shown that kinesiologic taping increases epidermal-dermal distance, and may reduce the sensation of pain, edema and inflammation. For better, faster and comfortable tissue healing with protection of soft-tissue integrity, kinesiologic taping may be a valuable treatment after contusion injury. However, these results should be supported by clinical studies.

A novel surgical technique for preserving the bladder neck during robot-assisted laparoscopic radical prostatectomy: preliminary results.

PURPOSE: To describe our new surgical technique for preserving the bladder neck during robot-assisted laparoscopic prostatectomy (RALP) and to present the anatomy between the bladder neck and prostate. METHODS: Between December 2012 and May 2014, 52 RALPs were performed at our institute. Demographic, perioperative, and postoperative data were recorded. Quality of life (QoL) scores were assessed before RALP, after urethral catheter removal, and at the first month after RALP. Fatty connective tissue between bladder neck and prostate was introduced, and circular muscle fibers of the internal sphincter were seen in all patients. Complications were classified according to the Clavien-Dindo classification. Statistical analyses were performed. RESULTS: Mean follow-up was 9.6±5.2 months; mean age was 61.1±6.5 years. Our novel surgical technique for preserving the bladder neck was performed in 52 patients, and they were continent after catheter removal; mean duration of the catheter was 9.4±1.4 days. There was a significant difference in QoL before RALP and after catheter removal, however, but there was no statistical difference between before and 1 month after RALP (respectively; P<0.001, P=0.5). Furthermore, there was no complication related to the bladder neck such as bladder neck stricture, acute/chronic urinary retention, as well as no Clavien III, IV, and V complications. In addition, conventional laparoscopy and/or open surgery was not needed in any of the RALP cases. CONCLUSION: Our novel technique provided very early continence at the time of catheter removal after RALP within short-term follow-up. This can help early recovery and develop QoL scores after RALP.

Demonstration of the nerve distribution of the extraocular muscles in rabbits (Oryctolagus cuniculus).

PURPOSE: The intramuscular nerve distribution of the extraocular muscles may be of utmost importance for better understanding of their physiologic and pathologic reactions. The aim of this study was to determine the entire intramuscular nerve distribution pattern of rabbit extraocular muscles by utilizing Sihler's staining technique. METHODS: Six New Zealand rabbits were used in order to demonstrate the intramuscular nerve distribution of the extraocular muscles by using Sihler's staining method. RESULTS: The number of extramuscular and intramuscular major nerve branches were higher in the inferior oblique muscle while the number of intramuscular minor nerve branches were higher in the superior oblique muscle when compared with the other extraocular muscles. The smallest number of extramuscular branch and intramuscular both major and minor branches were found in the medial rectus muscle. More complex anastomoses and a branching pattern were observed in the superior oblique and superior rectus muscle. The anastomosing nerve branches were observed to run in a "Y", "I" or "U"-shaped pattern in all of the extraocular muscles. Of all the extraocular muscles, the longest major nerve branches were observed in the retractor bulbi muscles. However, these branches had the smallest diameter. No morphological difference was observed between the two sides with regard to all the characteristics of the extraocular muscles. CONCLUSION: Sihler's neural staining technique could be quite useful in the demonstration of the intramuscular nerve distribution of extraocular muscles.

Intrauterine structure of foot muscles in talipes equinovarus due to high-level myelomeningocele: a light microscopic study in fetal cadavers.

The purpose of this study was to investigate the light microscopic structure of extrinsic foot muscles in talipes equinovarus (TEV) deformity that developed during intrauterine life due to high-level myelomeningocele. Ten feet of five fetal cadavers ranging in age from 18 to 20 weeks were dissected. Five feet had typical TEV deformity and the other five feet did not have any deformity (control group). Under light microscopic examination quantitative measurement of both muscle fiber sizes and fibrosis in the muscle tissue were performed to investigate the denervation muscle atrophy. Mean muscle fiber size of the TEV group was found to be significantly lower than that of the control group in all foot muscles except the gastrocnemius muscle. The proportion of fibrosis due to denervation atrophy was significantly higher in the TEV group than in the control group in all muscles. This situation was most evident in the peroneus longus muscle. It was concluded that muscular imbalance due to significant muscular atrophy might be the cause of TEV deformity that developed during intrauterine life due to high-level myelomeningocele.

Improving fat graft survival through preconditioning of the recipient site with microneedling.

Although fat grafts are considered the ideal soft-tissue fillers, the main concern dealing with this technique is not being able to predict long-term graft survival due to high absorption rates. The purpose of this study was to investigate the angiogenic effects of preconditioning the recipient area with micro-needling and to determine its overall impact on fat graft survival. The study consisted of a sham, control and study group. The source of fat was the Wistar albino rat inguinal fat pad while the recipient area was a dorsal subcutaneous pouch. The dorsal area was preconditioned with standard technique micro-needling 1-week prior to fat graft transfer in the study group while the control group did not undergo micro-needling. At the end of 15 weeks, morphological, biochemical, histological and immunohistochemical evaluation was carried out. Fat grafts in the study group had better integrity and a higher level of vascularity compared to the control group. Volume analysis demonstrated higher graft survival in the study group in comparison to the control group. Histomorphometric and immunohistochemical evaluation showed better graft integrity and uniform adipocytes, less fibrosis, less vacuolisation and inflammation and better vascularisation in the study group. Although higher triglyceride concentrations were measured for the study group, the difference between the two groups was statistically insignificant. In conclusion, fat grafting performed in an area preconditioned with micro-needling results in higher graft volume, better integrity and vascularisation and an overall higher graft survival rate.

Investigation of the nerve distribution pattern of leg muscles in rat.

Information about the distribution of intramuscular nerve fibres within the skeletal muscles will enhance the understanding of their morphological structure and functions. This study was designed to examine the entire intramuscular nerve distribution pattern in rat leg muscles. The tibialis cranialis, tibialis caudalis, extensor digitorum longus, flexor digitorum longus, gastrocnemius, peroneus longus and brevis muscles were dissected from origo and insertion points under a surgical microscope in seven rats. These skeletal muscles from right hindlimbs were stained with Sihler's stain. The diameter of extramuscular and major nerve branches, number of major and minor nerve branches and anastomoses were measured and photographed under a stereomicroscope. In addition, serial sections were obtained from the left hindlimb muscles with S100 immunohistochemical staining and transferred to the computer to reconstruct images. A significant difference was found between the gastrocnemius and tibialis caudalis (p < 0.001), flexor digitorum longus and tibialis caudalis (p < 0.003), and peroneus longus and tibialis caudalis (p < 0.049) with regard to the diameter of major branches. The gastrocnemius was significantly different from the flexor digitorum longus, peroneus longus, extensor digitorum longus, tibialis caudalis and tibialis cranialis with regard to the number of minor nerve branches (p < 0.001). Knowledge of the branching pattern and some key landmarks, such as the number and diameter of major and minor nerve branches and the number of anastomoses between the nerve branches of skeletal muscles, is helpful in surgical or therapeutic interventions and botulinum toxin injections in areas of high extramuscular and intramuscular nerve density.

Qualitative comparison of anatomical microdissection, Sihler's staining and computerized reconstruction methods for visualizing intramuscular nerve branches.

UNLABELLED: STATING BACKGROUND: This study was designed to examine the entire intramuscular nerve distribution pattern of various human skeletal muscles in fetuses. METHODS: In the present study rhomboid major, trapezius, long head of the biceps femoris and masseter muscles were investigated in five 18 weeks old fetal cadavers. Anatomical microdissection was applied to one fetal cadaver. In two fetuses, the extramuscular (main), major and minor nerve branches, and anastomosis were examined using Sihler's staining and labeling. In the remaining two fetuses, consecutive slices with 0.5 mm interval and 5 microm thickness were obtained from each skeletal muscle. These slices were stained with S100 for the demonstration of the nerve fibers and thereafter 3D reconstruction images were constituted using PC software. RESULTS: Anatomical microdissection, Sihler's staining and computerized reconstruction methods were compared to demonstrate the intramuscular nerve distribution pattern. Demonstration of the intramuscular minor nerve branches and anastomosis showed difficulties in anatomical dissected specimens when compared with three-dimensionally reconstructed images and specimens obtained with Sihler's staining technique. Nevertheless, anatomical dissection is a simple method whereas Sihler's technique and computer aided 3D reconstruction are complex methods and take a long time to complete. CONCLUSION: The obtained information exposed that staining technique and the 3D reconstructions appeared to provide better results than did anatomical dissection.