Morphological determination of glenohumeral joint and acromioclavicular joint with computed tomography / Determinación morfológica de la articulación glenohumeral y la articulación acromioclavicular con tomografía computarizada

SUMMARY: Although acute and chronic pathologies of the glenohumeral and acromioclavicular joints are frequently encountered in the population, the anatomy and morphometry are not fully known. The aim of this study is to determine the measurements of morphometric parameters according to age groups and sex in a large series of Turkish population. Nine hundred and forty-one shoulders computed tomography (CT) images were screened and those of subjects with healthy anatomical structure were included. Humeral head diameter (HDD) was measured on CT images. Measurements were made using 3D-CT images of: width (GW) and height (GH) of the glenoid cavity; width (CW) and height (CH) of the distal clavicular joint surface; and width (AW) and height (AH) of the acromial joint surface. Data were compared, stratified by age and sex. Images of 223 patients (118 men, 105 women) were analyzed. The following mean measurements were determined: HDD, 41.77±3.77 mm; GH, 34.66±3.26 mm; GW, 25.50±2.90 mm; CW, 14.85±3.51 mm; CH, 8.49±2.27 mm; AW, 12.97±2.94 mm; AH, 7.01±1.77 mm. When startified by sex, HDD (p<0.001), GH (p<0.001), GW (p<0.001), CW (p<0.001), CH (p=0.002), AW (p<0.001) and AH (p<0.001) measurements were significantly different and mean values were greater in men. Similarly for age, significant differences were found for GH (p=0.028), CW (p<0.001), AW (p<0.001), AH (p<0.001). The parametric values we have obtained in the Turkish population we measure differ from the measurements made in different populations according to age groups and sex. Knowing these features will contribute to treatment planning, implant and prosthesis applications.

Aunque las patologías agudas y crónicas de las articulaciones glenohumeral y acromioclavicular son frecuentes en la población, la anatomía y morfometría no se conocen por completo. El objetivo de este estudio fue determinar las medidas de los parámetros morfométricos según grupos de edad y sexo en una serie de individuos de población turca. Se examinaron 941 imágenes de tomografía computarizada (TC) de hombro y se incluyeron las de sujetos con una estructura anatómica sana. El diámetro de la cabeza humeral (HDD) se midió en imágenes de TC. Las mediciones se realizaron utilizando imágenes 3D-CT de: ancho (GW) y altura (GH) de la cavidad glenoidea; anchura (CW) y altura (CH) de la superficie articular clavicular; y anchura (AW) y altura (AH) de la superficie articular acromial. Los datos fueron comparados, estratificados por edad y sexo. Se analizaron imágenes de 223 pacientes (118 hombres, 105 mujeres). Se determinaron las siguientes medidas medias: HDD, 41,77±3,77 mm; GH, 34,66 ± 3,26 mm; GW, 25,50±2,90 mm; CW, 14,85±3,51 mm; CH, 8,49±2,27 mm; AW, 12,97±2,94 mm; AH, 7,01±1,77 mm. Cuando se inicia por sexo, HDD (p<0,001), GH (p<0,001), GW (p<0,001), CW (p<0,001), CH (p=0,002), AW (p<0,001) y AH (p <0,001) las mediciones fueron significativamente diferentes y los valores medios fueron mayores en los hombres. De igual forma para la edad se encontraron diferencias significativas para GH (p=0,028), CW (p<0,001), AW (p<0,001), AH (p<0,001). Los valores paramétricos que hemos obtenido en la población turca difieren de las medidas realizadas en diferentes poblaciones según grupos de edad y sexo. El conocimiento de estas características contribuirá a la planificación del tratamiento, aplicaciones de implantes y prótesis.

Morphometric evaluation of second to fifth metacarpals for retrograde intramedullary headless screw fixation / Evaluación morfométrica del segundo al quinto metacarpianos para la fijación retrógrada con tornillos intramedulares sin cabeza

SUMMARY: Intramedullary headless screw fixation has come to the fore in the treatment of metacarpal fractures in recent years with its advantages. Our aim was to evaluate the metacarpal morphometry for retrograde intramedullary entrance and to determine the optimal entry point. Computed tomography images of 105 patients including 64 men and 41 women, were examined. Distal and proximal metacarpal widths, medullary cavity width, cortex thickness and the measurements of the optimal entry site in volar-dorsal and radio-ulnar directions were measured in both coronal and sagittal planes. In the sagittal plane, the second metacarpal had the widest proximal width (16.29 mm), distal width was greatest in the third metacarpal (14.34 mm) which was significantly different between the sexes (p<0.001). Third metacarpal had the widest medullary cavity width in the sagittal plane (4.12 mm). In the coronal plane, it was the second metarcarpal with the widest proximal (16.14 mm) and distal width (13.92 mm) and was also the longest (66.32 mm). Unlike the sagittal plane, the medullary cavity width in the coronal plane was at the widest (4.06 mm) in fifth metacarpal. The points determined for optimal entry were respectively (4.60 mm; 4.97 mm; 4.55 mm; 4.36 mm) in the dorsal-volar plane, close to the dorsal side. There was no significant difference between the sexes for optimal insertion point in the sagittal planes in all the measured metacarpals. Considering its three dimensional structure, metacarpal bones have irregular morphometric properties and these features differ in sagittal and coronal planes. The optimal entry site is located in the midline in the coronal plane, while it is located in the sagittal plane close to the dorsal part. Knowing these properties can reduce the complication rate by reducing entry attempts and help select the correct material.

RESUMEN: En los últimos años, debido a sus ventajas la fijación intramedular con tornillos sin cabeza ha pasado a primer plano en el tratamiento de las fracturas de los huesos metacarpianos. Nuestro objetivo fue evaluar la morfometría del hueso metacarpiano para la entrada intramedular retrógrada y determinar el punto de entrada óptimo. Se examinaron imágenes de tomografía computarizada de 105 pacientes, incluidos 64 hombres y 41 mujeres. Los anchos de los huesos metacarpianos distal y proximal, el ancho de la cavidad medular, el grosor de la cortical y las medidas del sitio de entrada óptimo en las direcciones palmar-dorsal y radioulnar se midieron en los planos coronal y sagital. En el plano sagital, el segundo hueso metacarpiano presentó el mayor ancho proximal (16,29 mm), el ancho distal fue mayor en el tercer hueso metacarpiano (14,34 mm), lo que fue significativamente diferente entre individuos de ambos sexos (p<0,001). El tercer metacarpiano tenía la cavidad medular más ancha en el plano sagital (4,12 mm). En el plano coronal, era el segundo hueso metarcarpiano con mayor ancho proximal (16,14 mm) y distal (13,92 mm) y también era el más largo (66,32 mm). A diferencia del plano sagital, el ancho de la cavidad medular en el plano coronal era más ancho (4,06 mm) en el quinto hueso metacarpiano. Los puntos determinados para la entrada óptima fueron respectivamente (4,60 mm; 4,97 mm; 4,55 mm; 4,36 mm) en el plano dorsal-volar, próximo del lado dorsal. No hubo diferencia significativa entre ambos sexos para el punto de inserción óptimo en los planos sagitales en todos los huesos metacarpianos medidos. Teniendo en consideración su estructura tridimensional, los huesos metacarpianos tienen propiedades morfométricas irregulares, y estas características difieren en los planos sagital y coronal. El sitio de entrada óptimo se encuentra en la línea mediana en el plano coronal, mientras que se ubica en el plano sagital cerca de la parte dorsal. Conocer estas propiedades puede reducir la tasa de complicaciones al disminuir los intentos de entrada y ayudar a seleccionar el material correcto.

Evaluation of medial and lateral meniscus thicknesses in early osteoarthritis of the knee with magnetic resonance imaging.

OBJECTIVE: To evaluate early changes occurring in both medial and lateral meniscus thickness from the knees of patients with osteoarthritis (OA). METHODS: We conducted this study in the Department of Anatomy and Division of Radiology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey during the period 2004 to 2005. In this study, we measured the thickness of the medial and lateral meniscus in a group of 36 (50 knees) consecutive patients with chronic knee pain, and clinical findings of early OA, and 10 (20 knees) control subjects using MRI. RESULTS: The thickness of the posterior horn of the medial meniscus and anterior horn of the lateral meniscus were significantly higher in the OA patients compared with the control subjects. CONCLUSION: This study showed that meniscal degeneration in early stage OA is not evenly distributed in the knee. Thickening of the menisci in some areas may occur due to their own localization and biomechanics.

A rare case of distal one-third of the transverse colon supplied by a branch from splenic artery.

We observed a rare variation of splenic artery during the routine dissection in the Laboratory of the Anatomy Department. It arose from the splenic artery toward the distal part of transverse colon which typically supplied by the inferior mesenteric artery. Embryologically distal part of the transverse colon is a segment of hindgut. In this case, splenic artery which an artery of foregut supplies an area of hindgut. The knowledge of splenic artery variations has significant importance during surgery of the organs of the upper abdominal region. In this study, we discussed clinical significance and embryological aspects of this anomalous artery.

Comparative study on apoptosis in the testes of normal and alcoholic rats.

OBJECTIVES: To investigate the tissue injury associated with long-term alcohol consumption in male gonads. To this end, apoptotic testicle tissues of alcoholic rats were compared with the testicle tissues of the control rats. METHODS: This study was conducted in the Department of Anatomy and Division of Pathology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey during the period 2002 to 2003. We used Sprague-Dawley rats as the subject material in the investigation of apoptosis. We divided the rats into 2 groups: alcoholic rats and the control group, with 10 adult male rats in each group. We housed the subjects in each group under controlled temperature (22 +/- 3 degrees C) and humidity (62 +/- 7%) and lighting (12 hours darkness and 12 hours daylight per day). We fed the rats in the alcoholic group by ethanol in liquid diet for 12 weeks while the control rats received the normal isocaloric diet. We fixed the testicle tissues of both groups by perfusion of 10% formaldehyde through left ventricle and then removed. We further fixed the tissues in formaldehyde solution for at least 2 days. After dehydration by ethanol, we embedded the tissue in paraffin and used serial paraffin sections (5 micron thickness) for immunohistochemistry. We used Caspase-3 Ab-4 (CPP32) antibody to identify caspase reaction in apoptotic regions. Hence, we observed the stained sections and photographed the apoptotic seminiferous tubules (ST). For comparison of apoptosis in the alcoholic group and control group, we counted the apoptotic germ cells in x 400 magnification under light microscope. RESULTS: The diameters of seminiferous tubules were measured using light microscope with micrometre. The findings were compared by computer and significant differences in apoptosis between 2 groups (p<0.01) were detected. CONCLUSION: Apoptosis is significantly induced in ethanol treated rat related to the overuse of ethanol. The findings indicate the tissue injury of testicles associated with alcohol consumption.

Volumetric determination of medial epicondyle and lateral epicondyle of humerus in male and female volleyball players.

The aim of this study was to assess the volume of the medial epicondyle and lateral epicondyle in comparison with the distal end of humerus volume in male and female elite athletes participating in an impact loading sport (volleyball). The volleyball group consisted of 17 female, aged 20.47 +/- 2.47 years (mean +/- SD), 16 male aged 21.68 +/- 3.47 years (mean +/- SD); training for about 8 hours/week. The control group consisted of 15 nonactive females aged 21.73 +/- 2.68 years (mean +/- SD) and 14 nonactive males aged 23.35 +/- 4.16 years (mean +/- SD). Anthropometric determinations (height, weight, limb length, girth of arm and forearm) were made on each subjects. Range of motion was evaluated by standard goniometric technique. Comparative plain films of both elbows were obtained in an anteroposterior projection. The volumes of the medial epicondyle and lateral epicondyle were determined by the principle of Cavalieri which is an effective stereologic volume calculation method. In the volleyball players, increased medial epicondyle volume was recorded in the dominant and nondominant arms as compared with the control subjects (P < 0.05). Wrist flexors are highly involved in spiking, blocking and serving in volleyball. In this study we founded volume of medial epicondyle which is the connection point of flexor muscle was increased because of loading.

A rare multiple variation of the greater omentum.

In a dissection performed in our department, we observed multiple variations of the greater omentum. The unusual attachments of the greater omentum were identified. While the right upper part combined with ligamentum teres hepatis, the left upper part had connection with the anterolateral abdominal wall. In addition, the free lower margin of the greater omentum was bound to the front of the abdomen wall. These unusual attachments contained vessels and nerves. The greater omentum is used in reconstructive surgery of the chest wall. And its ligaments are important in abdominal surgery. Therefore, it is important to keep in mind the different attachments of the greater omentum, so that caution is required during intraabdominal surgery and also in appropriately interpreting the radiographs.