Diagnostic value of soluble urokinase-type plasminogen activator receptor in patients with acute coronary syndrome: A systematic review and meta-analysis.

BACKGROUND: In contemporary clinical practice, there is an increasing need for new clinically relevant biomarkers potentially optimizing management strategies in patients with suspected acute coronary syndrome (ACS). This study aimed to determine the diagnostic utility of soluble urokinase-type plasminogen activator receptor (suPAR) levels in individuals with suspected ACS. METHODS: A literature search was performed in Web of Science, PubMed, Scopus, and the Cochrane Central Register of Controlled Trials databases, for studies comparing suPAR levels among patients with and without ACS groups. The methodological quality of the included papers was assessed using the Newcastle-Ottawa Scale (NOS). A fixed-effects model was used if I² < 50%; otherwise, the random-effects model was performed. RESULTS: Five studies with 3417 participants were included in the meta-analysis. Pooled analysis showed that mean suPAR levels in the ACS group were statistically significantly higher than in the control group (3.56 ± 1.38 vs. 2.78 ± 0.54 ng/mL, respectively; mean difference: 1.04; 95% confidence interval: 0.64-1.44; I² = 99%; p < 0.001). CONCLUSIONS: In the context of acute coronary syndrome, suPAR is a potential biomarker for the early identification of medical conditions in individuals who are being treated in emergency rooms.

Effectiveness of Bone Conduction Stimulation Applied Directly to the Otic Capsule Measured at Promontory: Assessment in Cadavers.

INTRODUCTION: The aims of this study included: (a) to develop a method of direct acoustic bone conduction (BC) stimulation applied directly to the otic capsule, (b) to investigate the effect of different stimulation sites on the promontory displacement amplitude, and (c) to find the best stimulation site (among 2 located directly on the otic capsule and 1 standard site approved for clinical use) that provides the greatest transmission of vibratory energy. METHODS: Measurements were performed on 9 cadaveric whole human heads. A commercial scanning laser Doppler vibrometer was used. The promontory displacement was recorded in response to BC stimulation delivered by an implant at 3 sites: BC1 on the squamous part of the temporal bone, BC2 on the ampulla of the lateral semicircular canal, and BC3 between the semicircular canals. The displacement of the promontory was analyzed in detail. RESULTS: The results show that BC1 caused an overall smaller promontory displacement than both sites BC2 and 3. BC3 stimulation is more efficient than that at BC2. CONCLUSIONS: BC is an effective method of acoustic stimulus delivery into the inner ear, with the effectiveness increasing when approaching closer to the cochlea. Placing the implant directly on the labyrinth and thus applying vibrations directly to the otic capsule is possible and very effective as proved in this study. The results are encouraging and represent the potential of new stimulation sites that could be introduced in the field of BC hearing rehabilitation as the possible future locations for implantable BC hearing devices.

Bone conduction stimulation of the otic capsule: a finite element model of the temporal bone.

PURPOSE: Bone conduction stimulation applied on the otic capsule may be used in a conductive hearing loss treatment as an alternative to the bone conduction implants in clinical practice. A finite element study was used to evaluate the force amplitude and direction needed for the stimulation. METHODS: A finite element model of a female temporal bone with a precisely reconstructed cochlea was subjected to a harmonic analysis assuming two types of stimulation. At first, the displacement amplitude in the form of air conduction stimulation was applied on the stapes footplate. Then the force amplitude was applied on the otic capsule in the form of bone conduction stimulation. The two force directions were considered: 1) the primary direction, when a typical opening is performed during mastoidectomy, and was coincident with the axis of an imaginary cone, inscribed in the opening, and 2) the direction perpendicular to the stapes footplate. The force amplitude was set so that the response from the cochlea corresponded to the result of air conduction stimulation applied on the stapes footplate. RESULTS: The amplitude and phase of vibration and the volume displacement on the round window membrane were considered as well as vibrations of the basilar membrane, spiral lamina, and promontory. CONCLUSIONS: The cochlear response was comparable for the two types of stimulation. The efficiency of bone conduction stimulation depended on the force direction. For the primary direction, the force was a few times smaller than for the direction perpendicular to the stapes footplate.

Round Window Membrane Motion Induced by Bone Conduction Stimulation at Different Excitation Sites: Methodology of Measurement and Data Analysis in Cadaver Study.

OBJECTIVES: The aim of this study was to investigate the following: (1) the vibration pattern of the round window (RW) membrane in human cadavers during air (AC) and bone conduction (BC) stimulation at different excitation sites; (2) the effect of the stimulation on the fluid volume displacement (VD) at the RW and compare the VD between BC and AC stimulation procedures; (3) the effectiveness of cochlear stimulation by the bone implant at different excitation sites. DESIGN: The RW membrane vibrations were measured by using a commercial scanning laser Doppler vibrometer. The RW vibration amplitude was recorded at 69 measurement points evenly distributed in the measurement field covering the entire surface of the RW membrane and a part of the surrounding bony surface. RW vibration was induced first with AC and then with BC stimulation through an implant positioned at two sites. The first site was on the skull surface at the squamous part of the temporal bone (implant no. 1), a place typical for bone-anchored hearing aids. The second site was close to the cochlea at the bone forming the ampulla of the lateral semicircular canal (implant no. 2). The displacement amplitude (dP) of the point P on the promontory was determined and used to calculate the relative displacement (drRW) of points on the RW membrane, drRW = dRW - dP. VD parameter was used to analyze the effectiveness of cochlear stimulation by the bone implant screwed at different excitation sites. RESULTS: RW membrane displacement amplitude of the central part of the RW was similar for AC and BC implant no. 1 stimulation, and for BC implant no. 2 much larger for frequency range >1 kHz. BC implant no. 2 causes a larger displacement amplitude of peripheral parts of the RW and the promontory than AC and BC implant no. 1, and BC implant no. 1 causes larger than AC stimulation. The effect of BC stimulation exceeds that of AC with identical intensity, and that the closer BC stimulation to the otic capsule, the more effective this stimulation is. A significant decrease in the value of VD at the RW is observed for frequencies >2 kHz for both AC and BC stimulation with BC at both locations of the titanium implant placement. For frequencies >1 kHz, BC implant no. 2 leads to a significantly larger VD at the RW compared to BC implant no. 1. Thus, the closer to the otic capsule the BC stimulation is located, the more effective it is. CONCLUSIONS: Experimental conditions allow for an effective acoustic stimulation of the inner ear by an implant screwed to the osseous otic capsule. The mechanical effect of BC stimulation with a titanium implant placed in the bone of the ampulla of the lateral semicircular canal significantly exceeds the effect of an identical stimulation with an implant placed in the temporal squama at a conventional site for an implant anchored in the bone. The developed research method requires the implementation on a larger number of temporal bones in order to obtain data concerning interindividual variability of the observed mechanical phenomena.

Adaptation to Hypoxia in Sleep Apnea Patients: Multifaceted Mechanisms.

Obstructive sleep apnea syndrome (OSA) is a form of sleep disordered breathing. The key phenomena are multiple repetitive pauses or restriction of airflow in the airway, defined as apnea and hypopnea. This study was based on a retrospective analysis of the results of polysomnographic (PSG) recordings of 230 adult patients (62 women and 168 men), being evaluated for OSA. The mean age, body mass index (BMI), apnea-hypopnea index (AHI), and pulse oximetry (SO2 nadir) of all patients were 50.4 ± 12.7 years, 30.4 ± 5.4 kg/m2, 33.6 ± 26.6 1/h, and 80.7 ± 12.1%, respectively. Statistical analysis was performed taking into account the moment of obstructive apnea occurrence and duration, sleep stage, and the SaO2 nadir associated with these events. We found a lengthening of apneic episodes with progressing of sleep-time, which depended on the sleep-time. There was rather a fast increase in apnea duration in the first quartile of sleep-time. In the later sleep phases, the dynamics of the increase were four-fold weaker. The lengthening of apnea duration was dependent on the severity of AHI, but was hardly related to the sleep stage or arterial desaturation. In conclusion, the results revealed two time scales of a lengthening of apneic episodes as a function of sleep-time in OSA patients. Sympathetic activation and spleen reflex may be involved in the observed phenomenon. Although the exact mechanisms of increasing duration of apneic episodes with the passage of sleep remain elusive, we believe these mechanisms are liable to be multifaceted.

Evaluation of the Sensory Organization Test to differentiate non-fallers from single- and multi-fallers.

BACKGROUND: Among the elderly, instability leading to falls (and consequences of them) is one of the most important problems. The etiology of falls is usually complex, but balance, posture and gait problems are considered to be the most important risk factors. OBJECTIVES: The objective of this study was to assess the usefulness of the Sensory Organization Test (SOT) in differentiating multi-fallers from single-fallers. MATERIAL AND METHODS: The studied group included 92 patients aged >60 years with balance disorders and falls in their history. The patients were divided into 2 groups: multi-fallers and single-fallers. The control group (non-fallers) included 21 individuals. The SOT was performed on the 1st day (SOT1) and on the last day (SOT2) of rehabilitation. Mean equilibrium score (ES) of 1-3 and 4-6 sensory conditions and composite score (CS) of the SOT1 and SOT2 were analyzed. The falls were analyzed as a total number of falls while performing SOT and a number of falls in all 3 repetitions of both conditions 5 and 6 separately. In SOT conditions 1-4 there were no falls observed. RESULTS: The importance of SOT to differentiate fallers from non-fallers and single-fallers from multi-fallers is ambiguous. CONCLUSIONS: The SOT may or may not indicate the differences between the groups - it does not fully explain those differences. It shows only postural dysfunction without indicating any localization in particular part of vestibular organ. The basic diagnostic evaluation in the elderly with a proneness to falls should include clinical examination and the Dix-Hallpike maneuver, supplemented with a videonystagmography (VNG), which would assess the structure of damage in vestibular organ. Posturography is of less validity in the differentiation of fallers from non-fallers.

The correlation of the results of the survey SNOT-20 of objective studies of nasal obstruction and the geometry of the nasal cavities.

INTRODUCTION: In this paper were verified the correlation between the results of the survey SNOT-20 and the results of the objective tests of nasal obstruction which are rhinomanometry and acoustic rhinometry before and after surgical treatment, such as septoplasty, septoconchoplasty, ethmoidectomy and septoethmoidectomy. MATERIAL AND METHODS: The material used in this study was 233 patients diagnosed routinely in the Rhinomanometry Laboratory of the Department of Otolaryngology at the Medical University of Warsaw, reporting rhinological problems. Data were obtained from 70 women (31,4%) ranging in ages from 18 to 81 years of age and 153 men (68,6%) ranging in ages from 16 to 81 years of age. The researches presented in the study were made using the device RhinoMetrics SRE 2100 which combines the Rhinomanometer (RhinoStream) and Acoustic Rhinometer (RhinoScan) Interacoustics AS (Denmark). Survey SNOT-20 (Sino-Nasal Outcome Test-20) in Polish was completed by patients before surgery and during the postoperative control visits. RESULTS: The calculated correlations between the objective parameter, which was the resistance to the flow of air through the nasal cavity , and the subjective feelings of respondents expressed in the survey SNOT-20 were generally weak, and statistical significance was achieved with respect to the first question survey (the severity of the nose obstruction) for all components of resistance flow. DISCUSSION: The feeling of nasal obstruction is the most reproducible and reliable complaint reported by the patient with rhinological problems.

Elastic Properties of the Annular Ligament of the Human Stapes--AFM Measurement.

Elastic properties of the human stapes annular ligament were determined in the physiological range of the ligament deflection using atomic force microscopy and temporal bone specimens. The annular ligament stiffness was determined based on the experimental load-deflection curves. The elastic modulus (Young's modulus) for a simplified geometry was calculated using the Kirchhoff-Love theory for thin plates. The results obtained in this study showed that the annular ligament is a linear elastic material up to deflections of about 100 nm, with a stiffness of about 120 N/m and a calculated elastic modulus of about 1.1 MPa. These parameters can be used in numerical and physical models of the middle and/or inner ear.

Identification and location of the cocaine and amphetamine regulated transcript (CART) in the abomasum of cattle.

The cocaine and amphetamine regulated transcript (CART) belongs to the group of peptides with anorexigenic properties and is present in many areas of the central and peripheral nervous systems of numerous mammalian species. Research has suggested an effect on the feeling of appetite and satiety; however, there are no clear clues as to the role of CART in specific organs, including the stomach. Considering the specificity of cattle feeding and digestion, CART may play a highly significant role possibly associated with the option of administering greater amounts of high-volume feeds. Based on the results of immunohistochemical staining of abomasum samples prepared from hybrid bulls, the presence of CART-positive structures and CART distribution were determined in the mucosa, submucosa and muscularis layers of the stomach. Abundant sites of CART were found in the myenteric plexus, nerve fibers innervating the myocytes of the myenteron, neuroendocrine cells of the diffuse neuroendocrine system and the submucous plexus. The preliminary stage of abomasal CART detection suggests that CART is an agent that strongly affects the regulation of motor activity involved in stomach emptying and in secretory functions of the stomach. However, further research is necessary to explain the relationship.

Differences in the perilymph fluid stimulation before and after experimental stapedotomy.

A stapedotomy surgery using a piston stapes prosthesis significantly modifies the perilymph fluid stimulation level and always leads to alteration of conditions in sound transmission through the cochlea. This paper shows the results of non-contact measurements of the stapes head velocity, a Teflon piston stapes prosthesis velocity and round window velocity conducted in freshly harvested human cadaver temporal bone specimens. The vibration patterns were measured within the frequency range of 0.4-10 kHz at the sound pressure level of 90 dB administered to the external auditory canal in the same specimen before and after experimental stapedotomy. It was shown that the vibrations of the stapes Teflon piston prosthesis and the physiological stapes are similar and approximately five-fold lower amplitude of the round window membrane vibrations compared to a physiologic situation is caused by piston shape of the stapes prosthesis. The results in this report are the part of a larger study designed to develop a new type of chamber stapes or whole middle ear prosthesis.

Vascularization of the mandibular condylar head with respect to intracapsular fractures of mandible.

BACKGROUND: Causes of mandibular condylar (condylar) head necrosis as a consequence of intracapsular mandibular fractures are still a subject of controversy. OBJECTIVES: To investigate why in some cases of intracapsular fractures condylar head necrosis occurs. MATERIAL: 58 human heads from the collection of Head and Neck Clinical Anatomy Laboratory, from the Institute of Physiology and Pathology of Hearing, Warsaw, Poland, constituted the material. STUDY: Head arterial tree injections, anatomical preparation with the use of standard set of microsurgical equipment and an operating microscope. RESULTS: The main source of condylar head vascularization is the inferior alveolar artery, supplying bone marrow of the whole mandible as well as its cortical layer. Additional arterial blood supplying comes from a various number (2-7) of branches supplying the temporomandibular joint capsule. They originate directly from the maxillary artery or from its primary branches: masseteric artery, external pterygoid artery or superficial temporal artery. Two rare variants of accessory mandibular head vascularization were encountered. The first (2 cases) was an arterial branch from the maxillary artery and the second (1 case) was a branch from the external pterygoid artery. In these cases the arterial supply of lateral part of temporomandibular joint capsule from other sources was reduced. CONCLUSION: Fractures resulting in the lateral part of the condylar head in isolation could be potentially threatened by necrosis because of poor vascularization.

Round window membrane motion before and after stapedotomy surgery - an experimental study.

This paper presents the results of non-contact measurements of the human ear round window (RW) membrane motion in freshly harvested human cadaver temporal bone specimens. A PSV 400 Scanning Laser Vibrometer system (Polytec, Waldbronn, Germany) was used to determine the effect of stapedotomy on the sound-induced displacement amplitude of the RW membrane. The vibration patterns were measured in the frequency range of 0.4-10 kHz in four specimens with air conduction stimulation at 90 dB SPL applied to the external auditory canal. It was shown that the vibration amplitude of the RW membrane after stapes piston prosthesis implantation, in comparison with a physiological specimen, was reduced several times. The motion of the RW membrane can be used to determine the cochlear stimulation for the evaluation of middle ear ossicle reconstruction, especially in the case of otosclerosis surgery.

Comparison of round-window membrane mechanics before and after experimental stapedotomy.

BACKGROUND: Surgical intervention within the area of the middle ear always leads to alteration of conditions in its biomechanical system. This fact may provide an explanation for the lack of expected auditory outcome, although an apparently good anatomic outcome was obtained. In the case of stapedotomy, the majority of patients report lack of satisfactory results for frequencies above 2,000 Hz. The effect has not been experimentally investigated yet. METHODS: This study, conducted in four human temporal bones, yielded a record of round-window membrane vibration amplitude and phase in the frequency function (400 Hz-10 kHz) at the sound intensity level of 90 dB administered to the external auditory canal in a physiologic condition and following implantation of a Teflon piston stapes prosthesis. The procedure of experimental stapedotomy was performed with the tympanic membrane preserved from the maximally dilated approach through the posterior tympanotomy. RESULTS: Stapes Teflon piston prosthesis implantation was found to cause approximately fivefold lower amplitude of round-window membrane vibrations compared to a physiologic situation for frequencies above 2 kHz in particular. CONCLUSIONS: After stapedotomy, with the use of a Teflon piston prosthesis, stimulation of inner ear structures diminishes, especially in higher frequencies.

Relative nasopharyngeal patency index as possible objective indication for adenoidectomy in children with orthodontic problems.

OBJECTIVES: Although the harmful influence of nasopharyngeal obstruction on the facial skeleton has been demonstrated, clear criteria to qualify children with adenoid hypertrophy and malocclusion for adenoidectomy have not been established yet. METHODS: Retrospective analysis of 148 patients qualified for orthodontic treatment (77 females and 71 males) at the age of 9-11 years (the average age was 10 years and 3 months). X-ray images performed with the use of a cephalostat were scanned and submitted for cephalometric assessment. The study investigated the correlation between standard cephalometric parameters and the value of relative nasopharyngeal flow defined as the ratio of the nasopharyngeal flow to the dimension of the entire nasopharynx. In statistics Bartlett's test, Tukey's test and Pearson's correlation coefficients were used. RESULTS: The value of relative nasopharyngeal lumen ranged from 0.0943 to 0.5532 with no significant differences between genders. The subjects were divided into decile groups for investigating the correlation with cephalometric parameters. The study demonstrated statistically significant negative correlations between relative nasopharyngeal flow and the following parameters: the angle between lines NA and NB (ANB), the angle between lines SN and ML (SN/ML), the posterior/anterior facial height ratio (Post.Fac.H./Ant.Fac.H.), the difference between the maxillary and mandibular length (difference maxillary/mandibular), the mandibular length (Co-Gn) and the lower anterior facial height (Sn-Me). The correlations generally referred to middle deciles: from the 40th to 80th decile. An apparent lack of significant correlations in patients located below the 40th decile, which corresponded to the value of relative nasopharyngeal flow up to 18%, may indicate, that this value constitutes a threshold and further decreasing it exceeds adaptive capabilities of the body. CONCLUSIONS: Relative nasopharyngeal flow below 38% should constitute an indication for adenoidectomy, due to the exceeded adaptive capabilities of the body.

Correlations between selected parameters of the human skull and orbit.

BACKGROUND: Correlations between selected metric parameters of the human skull and the orbit should be useful for anticipating probable dimensions of the orbit in living subjects. MATERIAL/METHODS: One hundred human skulls derived from medieval cemeteries in Poland and 20 additional contemporary skulls were investigated. Measurements were made with anthropometric caliper, vernier caliper and lead. RESULTS: For orbit depth, orbital coefficient was negatively correlated with the width and length coefficient of the skull, but skull length was positively correlated. The minimal distance between the anterior lacrimal crest and the optic canal had a positive correlation with the skull length and a negative correlation with the orbital coefficient. The distance between the fronto-zygomatic suture and the optic canal had a positive correlation with skull height and with orbit width. The distance between the infraorbital foramen and the optic canal had a negative correlation with the orbital coefficient. Empirical formulas were derived on the basis of the calculated means. These formulas allow prediction of the distances between important orbital structures and topographical points at the orbital entrance, based on skull dimensions which are easily measurable intravitally. CONCLUSIONS: We conclude that the actual distances inside the orbit can be determined on the basis of gender, length and height of the skull, the width of the orbit, and the orbital coefficient.

Patency of nasopharynx and a cephalometric image in the children with orthodontic problems.

OBJECTIVES: To study a possible impact of adenoidectomy on malocclusion on the base of cephalometry. METHODS: Retrospective analysis of 148 patients qualified into the orthodontic treatment (77 girls and 71 boys) at the age of 9-11 years (an average age: 10 years and 3 months). Material was divided into three groups, equalized regarding sex and age. The first one consisted of the patients after adenoidectomy, at the moment of orthodontic assessment without any organic pathology within a nasal cavity or nasopharynx. To the second group were included children who for different reasons were not a subject of adenoidectomy despite clinical diagnosis of adenoid hypertrophy. In the third group were patients whose only problem was malocclusion. X-ray pictures taken on a cephalostate were scanned and given to cephalometric assessment. In statistics Bartlett's test, Tukey's test and Pearson's correlation coefficients were used. RESULTS: The significant differences with respect to many skull parameters appeared among the groups. The inappropriate respiratory habits find their reflection mainly within anterior and lower anterior facial height, angle of mandibular plane, nasopharyngeal flow and dental parameters. An evident beneficial influence of adenoidectomy is observed within a period of 36-41 months after an operation. Nasopharyngeal flow is the most sensitive parameter indicating the respiratory conditions, and is strongly connected with the key cephalometric parameters. CONCLUSIONS: In cases of malocclusion of skeletal character, coexisting with adenoid hypertrophy, adenoidectomy should be carried out as early as possible.

Clinical anatomy of the superior orbital fissure and the orbital apex.

BACKGROUND: There are discrepancies between authors as far as topography of superior ophthalmic vein in the orbital apex is concerned. OBJECTIVES: The aim was to determine the location of the structures within the posterior part of the orbit and in the superior orbital fissure. MATERIAL: One hundred preparations of orbits were derived from the corpses sectioned in Forensic Medicine Department, University Medical School in Warsaw, Poland. STUDY DESIGN: Anatomical preparation was performed with use of standard set of microsurgical equipment and operating microscope. RESULTS: Nine various morphological types of the superior orbital fissure were distinguished. Among those were two main categories: type "a" characterised by a clear narrowing within the fissure and type "b" which lacked such narrowing. The type "a" and "b" fissures were also different in length whereby type "b" fissure was significantly shorter. A diversity of positioning of the soft structures within those types was successfully noted. In type "a" the superior ophthalmic vein was located typically, however in type "b" fissures it was significantly more often the lowest structure in the posterior part of the orbital apex (except for muscles and orbital fat). A short case report of patient with superior orbital syndrome was added. CONCLUSION: Position of soft tissue structures in superior orbital fissure depended on its morphological type.

Measurements of pre- and postpubertal human larynx: a cadaver study.

This study investigates the differences in proportion and structure of the larynx in both children and adults, as well as changes which the larynx undergoes during puberty and adolescence. Furthermore, we have tried to answer the question on the existence of laryngeal sexual dismorphism in pre-pubertal (or pubertal) children. Larynges of 20 adults (10 men and 10 women) and 34 larynges of children not more than 12 years of age were acquired from the Forensic Medicine Department of the Medical University of Warsaw, Poland. Methods used are based on (1) anatomical preparation, (2) anatomical description and (3) measurements performed with the use of a digital camera and a computer-aided system MULTISCAN. Statistics, the Student's test and Pearson's linear correlation coefficient were calculated. Results show that proportions of the larynx depend on the age of the individual. The younger the individual is the more slender the larynx would be. However, proportion is not gender-related and hence is about the same in both males and females of any given age-group. Nevertheless, basic parameters were larger in males.

Measurements of selected parameters of the guinea pig temporal bone.

On the basis of dissections of 32 temporal bones of the guinea pig, measurements were taken of selected size parameters of the temporal bone. The measurements performed included external and internal size parameters of the bone. Among these were the following: the length, width and height of the external and internal auditory meatus, the length of the incudomallear complex, the height of the attic, the full length and height of the tympanic cavity and the parameters characterising the localisation of the external orifice of the facial nerve. The semicircular canals are relatively large, the lateral canal being the largest and the posterior the smallest. The length of the spiral canal of the cochlea does not exceed 16 mm. It is worth noting that both the vertical and horizontal dimensions of the scala vestibuli and scala tympani only exceed 1 mm in the basal turn, decreasing significantly in the further turns to as little as decimal parts of a millimetre. This should be taken into account during all tests which require the introduction of examining instruments into the cochlear scala.

The morphology and morphometry of the foramina of the greater wing of the human sphenoid bone.

The greater wing of the human sphenoid bone is pierced by several foramina, which contain, as a main element, the venous anastomoses between the interior of the skull and the extracranial veins. Since data concerning these foramina are scarce in the literature, studies comprising the frequency of occurrence and morphology of the foramina of the greater wing of the human sphenoid bone were undertaken on 100 macerated skulls. We found that the foramen ovale is divided into 2 or 3 components in 4.5% of cases. Moreover, the borders of the foramen ovale in some skulls were irregular and rough. This may suggest, on radiological images, the presence of morbid changes, which might be the sole anatomical variation. Concurrent with the foramen ovale are accessory foramina. The foramen of Vesalius and the cavernous foramen were present in 17% and 33% of cases, respectively. The foramen of Vesalius was always single and the cavernous foramen also occurred in multiple form. The foramen spinosus and the foramen rotundum occurred as permanent elements of the skulls studied. The mean area of the foramina measured, excluding the foramen ovale, was not considerable, which may suggest that they play a minor role in the dynamics of blood circulation in the venous system of the head.