Posterolateral Paramass Approach to Lesions Located at the Anterior C1-2 Level: A Cadaver Study.

OBJECTIVE: A novel posteriolateral surgical approach is described that will provide safe access to intradural and extradural lesions located in the anterior part of the spinal cord (SC) at the C1-2 level and to the odontoid in single session. METHODS: A total of five cadavers and two dry C1 vertebrae were used in this study. The study involved obtaining computed tomography magnetic resonance imaging scans and magnetic resonance imaging of all cadaver groups before and after the procedures. Group 1: Control; Group 2: Unilateral C1 posterior arch was removed, the inferomedial part of C1 lateral mass was removed, and access the anterior and lateral aspects of the SC. Group 3: In addition, odontoid was removed, Group 4: In addition, unilateral C1- C2 screw was placed. Group 5: In addition, bilateral C1-C2 screw was placed. RESULTS: The median distance from the midpoint of C1 posterior tubercle to vertebral groove which was removed in groups is 21.4 ± 2.88 mm. The average width of C1 lateral mass was 13.4±2.4 mm. After the lateral mass was drilled, its width decreased to 10,2 mm.This area was sufficient to open a surgical corridor and reach the anterior of SC and odontoid. After the procedure, no instability was found in group 2 without instrumentation on computed tomography and magnetic resonance imaging scans. CONCLUSIONS: It is possible to access the anterior C1-C2 via a posterolateral paramass approach by drilling 20%-30% of the lateral mass, providing an open pathway for easy intervention in C1-C2 intradural lesions. It is also possible to perform odontoid resection using this approach.

The Effect of early active Movement following Repair of Extensor Tendons in Zone IV using three different suture Techniques - A cadaveric Study.

PURPOSE: The aim of this study was to investigate the effects of early active movement on the area repaired with three different suture techniques used in extensor tendon injuries in zone IV. MATERIALS AND METHODS: A total of nine cadaver's 35 extensor tendons from 9 intact upper extremities were used in this study. The proximal and distal borders of the extensor tendons in zone IV were marked. The distance between the proximal and distal border was measured with a 0.5 mm precision tape measure and the mid-point was marked. Intertendinous connections were dissected and loop sutures were prepared for each extensor digitorum. Afterwards, force was applied to each digit along the tendon axis from the loops inserted into the extensor tendons, to measure the extensor forces required to extend the MCP joints to 0˚ with a hand scale. The flexor tendons of the digits were dissected at zone III, and loop sutures were prepared individually for the tendons to enable independent flexion for each digit. The force required to fully flex the digits was measured with a hand scale. The extensor tendons were incised transversely and repaired at the mid-point in zone IV with three different suture techniques (double Kessler, double figure of eight, running interlocking horizontal mattress (RIHM)). The extenxor tendon lengths in zone IV were re-measured for all digits after suturing. The predetermined forces required for full flexion and extension of the digits were applied to the repaired digits. After force was applied 20 times to each tendon, the gap formation was checked. Totally 200 flexion and 200 extension movements were applied to each finger with the help of a hand-held scale. Formation of 2-mm gap was failure criteria. At the end of the movements the extent of the gaps was recorded. In the absence of insufficiency at the repair site, 50 additional flexion and extension movements with double the previously recorded forces were applied to the tendons. RESULTS: There was a significant shortening of the extensor tendons after repair independent from the used suture technique. No significant gap formation was detected in all three suture techniques. CONCLUSION: All three suturing techniques are reliable for early active movements following the zone IV extensor tendon repairs. Therefore, surgeons can choose one of those three suture techniques to repair extensor tendon injuries in zone IV.

Diagnostic utilities of tracheal ultrasound and USB-endoscope for the confirmation of endotracheal tube placement: A cadaver study.

OBJECTIVES: Confirmation of the endotracheal tube placement (CoETP) has the utmost importance in the management of an airway. Visualization of tracheal rings or carina with a fiber-optical bronchoscope (FOB) has considered to be a reliable method for the CoETP. However, FOB is expensive, time-consuming, and not always practical. Inexpensive endoscopic USB-cameras were shown to aid intubation successfully and reliably. On the other hand, there have been no studies investigating their use for the CoETP. Tracheal ultrasonography (TUS) is also a new, inexpensive and widely available alternative. A cadaver study has planned to evaluate the diagnostic utility of TUS and a USB-camera. METHODS: This study was conducted in the Anatomy Lab of a University on a fresh frozen female cadaver. Three senior Emergency Physicians have intubated the cadaver, and performed TUS or USB-endoscopy. We have prepared a randomized intubation list (n=96) in three blocks (3 times 32) as to include equal number of esophageal and tracheal intubations (48 for each). Each EP is performed all three interventions (intubation, TUS and USB-endoscopy) in consecutive blocks of 32 intubations, in turn. The position of the tube has been verified from a 2cm wide ostium on the proximal trachea. RESULTS: In this study, all intubations (n=96, 100%) were correctly identified as tracheal or esophageal with both TUS and USB-camera. Both the sensitivity and specificity of TUS and USB-endoscopy for the CoETP were 100.0%. CONCLUSION: The perfect accuracy of TUS and USB-endoscopy, have placed those techniques in a unique position as an alternative in resource-poor situations.

Glutamic acid decarboxylase isoform distribution in transgenic mouse septum: an anti-GFP immunofluorescence study.

The septum is a basal forebrain region located between the lateral ventricles in rodents. It consists of lateral and medial divisions. Medial septal projections regulate hippocampal theta rhythm whereas lateral septal projections are involved in processes such as affective functions, memory formation, and behavioral responses. Gamma-aminobutyric acidergic neurons of the septal region possess the 65 and 67 isoforms of the enzyme glutamic acid decarboxylase. Although data on the glutamic acid decarboxylase isoform distribution in the septal region generally appears to indicate glutamic acid decarboxylase 67 dominance, different studies have given inconsistent results in this regard. The aim of this study was therefore to obtain information on the distributions of both of these glutamic acid decarboxylase isoforms in the septal region in transgenic mice. Two animal groups of glutamic acid decarboxylase-green fluorescent protein knock-in transgenic mice were utilized in the experiment. Brain sections from the region were taken for anti-green fluorescent protein immunohistochemistry in order to obtain estimated quantitative data on the number of gamma-aminobutyric acidergic neurons. Following the immunohistochemical procedures, the mean numbers of labeled cells in the lateral and medial septal nuclei were obtained for the two isoform groups. Statistical analysis yielded significant results which indicated that the 65 isoform of glutamic acid decarboxylase predominates in both lateral and medial septal nuclei (unpaired two-tailed t-test p < 0.0001 for LS, p < 0.01 for MS). This study is the first to reveal the dominance of glutamic acid decarboxylase isoform 65 in the septal region in glutamic acid decarboxylase-green fluorescent protein transgenic mice.

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

Morphometric measurements of cranial nerves in posterior cranial fossa of fetus cadavers were carried out in an attempt to identify any asymmetry in their openings into the cranium. Twenty-two fetus cadavers (8 females, 14 males) with gestational age ranging between 22 and 38 weeks (mean 30 weeks) were included in this study. The calvaria were removed, the brains were lifted, and the cranial nerves were identified. The distance of each cranial nerve opening to midline and the distances between different cranial nerve openings were measured on the left and right side and compared. The mean clivus length and width were 21.2 ± 4.4 and 13.2 ± 1.5 mm, respectively. The distance of the twelfth cranial nerve opening from midline was shorter on the right side when compared with the left side (6.6 ± 1.1 versus 7.1 ± 0.8 mm, p = 0.038). Openings of other cranial nerves did not show such asymmetry with regard to their distance from midline, and the distances between different cranial nerves were similar on the left and right side. Cranial nerves at petroclival region seem to show minimal asymmetry in fetuses.

Expression of NADPH-d in the vagal nuclei of the chronic esophagitis model in rats.

AIM: To evaluate the changes in the number of NADPH diaphorase (NADPH-d) stained neurons in the vagal nuclei in a chronic esophagitis model. MATERIALS AND METHODS: There were 3 groups of rats examined: 1) a chronic gastroesophageal reflux rat group, which was created by a partial gastric outlet obstruction; 2) a sham group; and 3) a ranitidine treated group. Serial sections ofbrainstems of all groups were cut and NADPH-d staining, which selectively stains the nitric acid synthase-containing neurons, was done. RESULTS: Histopathological changes due to chronic reflux esophagitis was observed in the reflux group. The ranitidine treatment and sham control groups showed no changes related to esophagitis. The staining in the dorsal motor nucleus of the vagus and nucleus tractus solitarius showed statistically significant differences compared to the control group (P < 0.0001). CONCLUSION: The increased nitric oxide expressions in the dorsal vagal nucleus and nucleus tractus solitarius are most probably due to adaptive changes to disturbed esophageal motility and mucosal damage.

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

BACKGROUND: The index finger to ring finger length ratio (2D:4D) of the right hand are affected by prenatal testosterone levels in male. To date, it has been determined that the high 2D:4D ratio is related to the myocardial infarction, however no research has revealed the relationship between the high 2D:4D ratio whose coronary artery shows atherosclerotic plaque development. OBJECTIVE: The aim of this study was to display the relationship between the 2D:4D ratio and atherosclerosis formation in male autopsy cases. METHODS: We designed a study in 100 heterosexual male autopsies whose mean age was 21.4+/-2.47 (range between 17 and 25). The 2nd and 4th digits were measured on the palmar surface of the right hand and taken the right coronary artery to show the atherosclerotic plaque development. RESULTS AND CONCLUSION: Grade 3 group had significantly higher 2D:4D ratio compared to Grade 1 and Grade 2 groups (p=0.02 for both).