Volumetric and Asymmetric Index Analysis of Subcortical Structures in Multiple Sclerosis Patients: A Retrospective Study Using volBrain Software.

Introduction Multiple sclerosis (MS) is a chronic and autoimmune disease that has a significant influence on the central nervous system, such as the brain and spinal cord, affecting millions of individuals globally. Understanding the connection between subcortical brain regions and MS is crucial for effective diagnostic and therapeutic approaches for treating this disabling disease. This study explores the relationship between volume and contours of asymmetry index of subcortical brain regions in individuals with MS using volBrain software (https://www.volbrain.net; developed by José V. Manjón (Valencia Polytechnic University, Valencia, Spain) and Pierrick Coupé (University of Bordeaux, Bordeaux, France)). Methods In our retrospective investigation, we admitted 100 Turkish individuals, comprising 50 patients diagnosed with relapsing-remitting MS (RRMS) (24 (48%) males and 26 (52%) females) and 50 healthy controls (23 (46%) males and 27 (54%) females), registered between October 2017 and February 2022 for five years and underwent assessment in the radiology department at the Teaching and Research Hospital of Kocaeli University; 1,150 Turkish patients were excluded from our study based on our exclusion criteria. We used magnetic resonance imaging with a 3-Tesla (3T) scanner and volBrain software to assess volumes (cm3) and asymmetry indexes due to asymmetry for different levels of atrophy of total intracranial, total brain, gray matter, white matter, and subcortical regions, the most affected regions in MS patients for both patient and control cohorts. Results Statistical analysis revealed a significant difference between patient and control groups (p < 0.001), with patient group mean age at 38.32 years and control group mean age at 32.88 years. Patient group exhibited lower values for total intracranial, total brain, gray matter, white matter, and cerebrospinal fluid volume compared to control group (p < 0.05). The results indicated a statistically significant decrease (p < 0.05) in the values for total intracranial and total brain volume, whereas all other values remained unchanged. We compared volumes of subcortical structures on the right and left sides and found that the putamen, thalamus, and globus pallidus had statistically lower values in the patient group than in the control group (p < 0.001), apart from the lateral ventricle. Furthermore, our retrospective investigation demonstrated a statistically significant difference in the globus pallidus asymmetry index, indicating a preference for the patient group (p < 0.05). A lower asymmetry index value signifies a larger volume for the right side of the subcortical regions of the brain when compared to the left side. Conclusion Brain atrophy, although characterized by irreversible tissue damage, is targeted by therapeutic interventions to prevent progression. It is, therefore, imperative to develop a universally accepted measurement standard for subcortical structures that also considers the inherent variability present within each structure. Our findings serve as an important basis and indicator for the determination of subcortical atrophy and asymmetry in MS, the prognosis of the disease, and the etiology of clinical symptoms. Subsequent research may benefit by adopting the novel approach of considering brain atrophy as an outcome rather than a predictor, thereby facilitating the elucidation of the intricate biological mechanisms that give rise to volume loss.

Superior mesenteric artery revisited using magnetic resonance angiography.

PURPOSE: We aimed to examine the superior mesenteric artery in detail by magnetic resonance angiography to provide an alternative to other imaging methods, to reduce the exposure time of patients and physicians to X-rays and the time spent in catheter angiography, to determine the variations, positions, and locations of the celiac trunk, and to provide detailed information for surgeons and interventional radiologists using this method. METHODS: The procedures were approved by the Kocaeli University Medical School Non-Interventional Clinical Research Ethics Committee (10.04.2023, approval number: 2021/51). MR angiography images of 185 patients with abdominal imaging in PACS (Picture Archiving Communication Systems) were retrospectively registered. The level of origin of the superior mesenteric artery according to the vertebral column, angle of origin, distance between the superior mesenteric artery and branches of the abdominal aorta, and branching pattern of the superior mesenteric artery were evaluated. Parameters were evaluated according to gender and age using SPSS version 25. RESULTS: The distance between superior mesenteric artery-inferior mesenteric artery and superior mesenteric artery-aortic bifurcation in males was higher than in females, and the difference was statistically significant. In females and the whole study group, a low, positive and significant relationship was found between age and superior mesenteric artery-sagittal angle. The most common origin site for the superior mesenteric artery, according to the vertebral column was found to be at L1 middle for males and L1 upper for females. The most common superior mesenteric artery branching pattern was classical type in both genders. CONCLUSION: Individual evaluation of the superior mesenteric artery could reduce the risks during surgical interventions, considering the relationship of the superior mesenteric artery, especially with distally located vessels, and the gender differences for the angle of origin. Furthermore, considering that interventional radiologists choose the catheter according to the angle of origin of the artery during catheter angiography procedures, individual evaluation of patients taking into account gender and age is of utmost importance.

Evaluation of the celiac trunk and its branching pattern by magnetic resonance angiography.

OBJECTIVE: The study aimed to examine the celiac trunk (CT) in detail by magnetic resonance angiography, to determine the locations, positions and variations of the CT, to provide detailed information for surgeons and interventional radiologists, and to reduce the time spent in the catheter angiography. MATERIAL AND METHODS: MR angiography images of 185 patients with abdominal imaging in PACS (Picture Archiving Communication Systems) were retrospectively analyzed. The level of origin of CT, according to the vertebral column, angle of origin, distance between CT and branches of the abdominal aorta (AA), and the branching pattern of CT were evaluated. Parameters were evaluated according to gender and age. RESULTS: The most common origin site for CT, according to the vertebral column, was found to be at T12-L1 in both genders. There was a low, positive correlation between age and CT-Sagittal angle (SA) in the whole study group (p<0.05). The most common CT branching pattern was the hepatogastrosplenic trunk in both genders, according to Adachi and Uflkacker's classification. The distance between CT and the inferior mesenteric artery (IMA) and CT and the aortic bifurcation (AB) of males was greater than in females, and the differences were statistically significant (p<0.05). CONCLUSION: Knowledge of the locations, positions, and variations of CT is essential in the diagnosis, differential diagnosis and decision-making mechanisms regarding the type of intervention to be performed for this vessel and related structures. In addition, the fact that data on these vessels can be obtained by MR angiography due to the improved image quality will prevent patients and physicians from the problems caused by the ionizing radiation of computed tomography. The data presented will constitute a basis for detailed and individualized interpretation and evaluation of each patient, as they provide important details about the configuration of the CT concerning gender and age using MRA.

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 subchronic formaldehyde exposure in rats with open field test / Evaluación de la exposición al formaldehído subcrónico en ratas con prueba de campo abierto

SUMMARY: Formaldehyde (FA), which is an indispensable chemical substance in anatomy and pathology, is a very harmful substance for living things. In our study, the purpose was to investigate the changes in behavior of rats exposed to subchronic formaldehyde with open field test. We divided 24 Wistar-Albino rats into 3 groups. The first group (n=8) was identified as the control group, and normal air breathing was ensured. Low-dose FA (mean 1 ppm) was inhaled in the second group, and high-dose FA (mean 10 ppm) was inhaled in the third group. FA exposure was done for 4 hours, 12 weeks, and 5 days a week. The rats were subjected to open field test during the first week and the last week of FA exposure. We observed significant decreases in the number of vertical movements and grooming in rats in the experimental group compared to the control group in the open field test (p 0.05). As a conclusion, we can argue that FA causes changes in the behaviors of rats regardless of dose and duration.

RESUMEN: El formaldehído (FA), una sustancia química indispensable en la anatomía y patología, pero es un elemento sumamente nocivo para todos los seres vivos., El objetivo de nuestro estudio fue investigar los cambios en el comportamiento de ratas expuestas a formaldehído subcrónico con prueba de campo abierto. Utilizamos 24 ratas Wistar-Albino divididas en 3 grupos. El primer grupo (n = 8) se identificó como el grupo de control y se aseguró una respiración normal de aire. En el segundo grupo se inhalaron dosis bajas de FA (media de 1 ppm) y en el tercer grupo se inhalaron dosis altas de FA (media de 10 ppm). La exposición a FA se realizó durante 4 horas, 12 semanas y 5 días a la semana. Las ratas fueron sometidas a una prueba de campo abierto durante la primera semana y la última semana de exposición a FA. Observamos disminuciones significativas en el número de movimientos verticales y acicalamiento en ratas en el grupo experimental en comparación con el grupo control en la prueba de campo abierto (p 0,05). Como conclusión, podemos argumentar que la AF provoca cambios en el comportamiento de las ratas independientemente de la dosis y la duración.

IInvestigation of possible oxidative damage caused by formaldehyde exposure in the rat's heart and aorta tissue / Investigación de posible daño oxidativo causado por la exposición al formaldehído en el corazón de la rata y tejido de la aorta

SUMMARY: Formaldehyde (FA) is a toxic substance used frequently in the field of medicine as well as in many industrial areas. Especially people working in the field of anatomy, histology, and pathology are in high risk group because of the use of the FA. Studies showing the effects of FA on the cardiovascular system are few in number. The purpose of the present study was to investigate the effects of FA exposure, which we believe can cause oxidative stress, on the heart and aorta with various biochemical analyses. A total of 24 Wistar Albino rats were used in our study. We divided the rats into 3 groups as the Control Group (CG), the group exposed to low-dose FA (avg. 1 ppm) (DDG) Group, and the group exposed to high-dose FA (avg. 10 ppm) (YDG). At the end of the subchronic FA exposure, the blood samples, heart and aorta tissues of the rats were taken and subjected to biochemical analyses. As a result of the analyses, statistically significant differences were detected between CG (2.96?0.85 ng/mg), and HDG (2.08?0.77 ng/mg) in aortic tissues in TXNIP analysis (p<0.05). In heart tissues, significant differences were detected between CG (0.73?0.27 ng/mg) and LDG (1.13?0.22 ng/mg) (p<0.05). Statistically significant differences were also detected between CG (1.98?0.31 mM/ml) and YDG (2.43?0.31 mM/ml) in serum MDA analyses (p<0.05). It was shown that subchronic application of FA to LDG rats through inhalation had no effects on apoptosis markers in heart tissues. More studies are required to show FA toxicity and the mechanism of action of pathology on the cardiovascular system. We believe that our study will contribute to clarifying the roles of mild and subchronic exposure of FA in heart and aortic tissues in terms of oxidative stress risk.

RESUMEN: El formaldehído es una sustancia tóxica que se utiliza con frecuencia en el campo de la medicina, así como en muchas áreas industriales. Especialmente las personas que trabajan en el area de la anatomía, y patología se encuentran en el grupo de alto riesgo debido al uso de esta sustancia. Pocos son los estudios que muestran los efectos del formaldehído en el sistema cardiovascular. El propósito del presente estudio fue investigar a través de análisis bioquímicos, los efectos de la exposición a formaldehído, que podría causar estrés oxidativo, en el corazón y la aorta. Se utilizaron un total de 24 ratas Albinas Wistar. Dividimos a las ratas en 3 grupos: grupo control (GC), grupo expuesto a dosis bajas de AG (promedio 1 ppm) (DDG) y grupo expuesto a dosis altas de AG (promedio 10 ppm) (YDG). Al término de la exposición a FA subcrónica, se tomaron muestras de sangre, tejido cardíaco y aorta de las ratas y se sometieron a análisis bioquímicos. Como resultado de los análisis, se detec- taron diferencias estadísticamente significativas entre GC (2,96 ? 0,85 ng / mg) y HDG (2,08 ? 0,77 ng / mg) en los tejidos aórticos en el análisis TXNIP (p <0,05). En los tejidos cardíacos se detectaron diferencias significativas entre GC (0,73 ? 0,27 ng / mg) y LDG (1,13 ? 0,22 ng / mg) (p <0,05). También se detectaron diferencias estadísticamente significativas entre CG (1,98 ? 0,31 mM / ml) y YDG (2,43 ? 0,31 mM / ml) en los análisis de MDA en suero (p <0,05). Se demostró que la aplicación subcrónica de formaldehído a ratas LDG a través de la inhalación no tuvo efectos sobre los marcadores de apoptosis en los tejidos del corazón. Se requieren más estudios para demostrar la toxicidad de los AG y el mecanismo de acción de la patología en el sistema cardiovascular. Creemos que nuestro estudio contribuirá a aclarar las funciones de la exposición leve y subcrónica de formaldehído en los tejidos cardíacos y aórticos en términos de riesgo al estrés oxidativo.

[The need for supplemental blocks in single versus triple injections in infraclavicular brachial plexus blocks with a medial approach: a clinical and anatomic study]. / Bloqueio complementar de nervos no bloqueio de plexo braquial infraclavicular com técnica medial de injeção única versus tripla: estudo anátomo­clínico.

BACKGROUND AND OBJECTIVES: To evaluate the single-injection and triple-injection techniques in infraclavicular blocks with an ultrasound-guided medial approach in terms of block success and the need for supplementary blocks. METHODS: This study comprised 139 patients who were scheduled for elective or emergency upper-limb surgery. Patients who received an infraclavicular blocks with a triple-injection technique were included in Group T (n=68). Patients who received an infraclavicular blocks with a single-injection technique were included in Group S (n=71). The number of patients who required supplementary blocks or had complete failure, the recovery time of sensory blocks and early and late complications were noted. RESULTS: The block success rate was 84.5% in Group S, and 94.1% in Group T without any need for supplementary nerve blocks. The blocks were supplemented with distal peripheral nerve blocks in 8 patients in Group S and in 3 patients in Group T. Following supplementation, the block success rate was 95.8% in Group S and 98.5% in Group T. These results were not statistically significant. A septum preventing the proper distribution of local anesthetic was clearly visualized in 4 patients. The discomfort rate during the block was significantly higher in Group T (p <0.05). CONCLUSION: In ultrasound-guided medial-approach infraclavicular blocks, single-injection and triple-injection techniques did not differ in terms of block success rates. The need for supplementary blocks was higher in single injections than with triple injections. The presence of a fascial layer could be the reason for improper distribution of local anesthetics around the cords.

Pecha Kucha with Part-Task Training Improves Airway Management in Fresh Frozen Cadavers: A Case-Control Observational Study.

OBJECTIVE: The objective of this study was to ascertain whether the addition of part-task training as a step in Pecha Kucha for fiberoptic tracheal intubation increases the success rate and reduces the complication rate. SUBJECTS AND METHODS: The residents of the Department of Anesthesiology were initially included in an orientation program. We used the Pecha Kucha method for the presentation of teaching fiberoptic intubation skills. Afterwards the participants were trained in Laerdal® airway management and each participant performed tracheal intubation using the Aintree catheter. The participants were divided into two groups. Group 1 (n = 9) received part-task training and group 2 (n = 9) received whole-task training. The tracheal intubation performances of participants were evaluated on fresh frozen cadavers. The number of interventions, incidence of complications, success rate, and optimization maneuver requirements were recorded. RESULTS: Eighteen residents aged between 27 and 33 years were included. All were junior residents with less than 2 years of experience. There was no significant difference in terms of duration of tracheal intubation, complication rates, and optimization maneuvers between the study groups. Six participants could not place the tracheal tube in the last section. The success rates for the part-task group during Aintree and tracheal tube placement were 100 and 66.7%, respectively, whereas the rates were 55.6 and 44.4%, respectively, in whole-task group (p < 0.05). CONCLUSION: In addition to the Pecha Kucha method in fiberoptic intubation training, simulation-based part-task training appears to increase the success rate and to reduce the complication rate on fresh frozen cadavers.

The need for supplemental blocks in single versus triple injections in infraclavicular brachial plexus blocks with a medial approach: a clinical and anatomic study / Bloqueio complementar de nervos no bloqueio de plexo braquial infraclavicular com técnica medial de injeção única versus tripla: estudo anátomo-clínico

Abstract Background and objectives: To evaluate the single-injection and triple-injection techniques in infraclavicular blocks with an ultrasound-guided medial approach in terms of block success and the need for supplementary blocks. Methods: This study comprised 139 patients who were scheduled for elective or emergency upper-limb surgery. Patients who received an infraclavicular blocks with a triple-injection technique were included in Group T (n = 68). Patients who received an infraclavicular blocks with a single-injection technique were included in Group S (n = 71). The number of patients who required supplementary blocks or had complete failure, the recovery time of sensory blocks and early and late complications were noted. Results: The block success rate was 84.5% in Group S, and 94.1% in Group T without any need for supplementary nerve blocks. The blocks were supplemented with distal peripheral nerve blocks in 8 patients in Group S and in 3 patients in Group T. Following supplementation, the block success rate was 95.8% in Group S and 98.5% in Group T. These results were not statistically significant. A septum preventing the proper distribution of local anesthetic was clearly visualized in 4 patients. The discomfort rate during the block was significantly higher in Group T (p < 0.05). Conclusion: In ultrasound-guided medial-approach infraclavicular blocks, single-injection and triple-injection techniques did not differ in terms of block success rates. The need for supplementary blocks was higher in single injections than with triple injections. The presence of a fascial layer could be the reason for improper distribution of local anesthetics around the cords.

Resumo Justificativa e objetivos: Avaliar as técnicas de injeção única e tripla no bloqueio infraclavicular, empregando-se acesso medial guiado por ultrassonografia, comparando-se o sucesso do bloqueio e a necessidade de bloqueios complementares. Método: O estudo incluiu 139 pacientes com indicação de cirurgia de membro superior eletiva ou de emergência. O Grupo T (n = 68 pacientes) recebeu bloqueio infraclavicular com técnica de injeção tripla e o Grupo S (n = 71), bloqueio infraclavicular com injeção única. Registrou-se o número de pacientes que necessitaram bloqueio complementar de nervo ou que apresentaram falha completa do bloqueio, o tempo de recuperação do bloqueio sensorial e as complicações precoces e tardias. Resultados: A taxa de sucesso do bloqueio infraclavicular, sem necessidade de bloqueio complementar de nervo, foi 84,5% e 94,1% para os Grupos S e T, respectivamente. No bloqueio infraclavicular foi necessário bloqueio de nervos periféricos distais em 8 e 3 pacientes dos Grupos S e T, respectivamente. Após a complementação, a taxa de sucesso do bloqueio foi 95,8% e 98,5% para os Grupos S e T, respectivamente. Os resultados não foram estatisticamente significantes. Imagem de septo impedindo a distribuição adequada do anestésico local foi claramente visualizada em quatro pacientes. A taxa de desconforto durante a realização do bloqueio foi estatatisticamente mais alta no Grupo T (p< 0,05). Conclusões: As técnicas de injeção única e tripla em bloqueio infraclavicular guiado por ultrasonografia com acesso medial não diferiram quanto à taxa de sucesso. A necessidade de bloqueio complementar foi maior com a técnica de injeção simples. A ocorrência de invólucro de fascia poderia justificar a distribuição inadequada do anestésico local ao redor dos fascículos do plexo.

Superior Hypogastric Plexus Blocks for Postoperative Pain Management in Abdominal Hysterectomies.

OBJECTIVE: To evaluate the efficacy of intraoperative superior hypogastric plexus (SHP) blocks on postoperative pain management in abdominal hysterectomies. MATERIALS AND METHODS: A total of 78 female American Society of Anesthesiologists grade I or II patients who underwent elective total abdominal hysterectomy for benign reasons were assessed for eligibility. After exclusion of patients who did not fulfill the inclusion criteria, 60 patients were evaluated in 2 groups: patients who had intraoperative SHP block (SHP; n=30), and patients who did not have intraoperative SHP block (No-SHP; n=30). RESULTS: There was no statistically significant difference between the 2 groups in demographic attributes, surgical duration, and length of hospital stay. Opioid requirements in both the postanesthesia care unit and gynecology ward, and nonsteroidal anti-inflammatory drug requirements in the ward were statistically significantly higher in the No-SHP group (P<0.05). Rescue analgesic times were found to be significantly longer in the SHP group (627±352.9 min; P<0.05). All visual analogue scale score assessments were found to be statistically significantly lower in the SHP group (P<0.05). No complications related to the SHP blocks were observed. CONCLUSIONS: Intraoperative SHP blocks in abdominal hysterectomies appear to be promising methods for acute postoperative pain management as part of a multimodal analgesia regimen. Although single SHP blocks provide adequate pain relief and reduce analgesic consumption, these blocks might have better results when used together with somatic nerve blocks, including abdominal wall blocks or wound site infiltrations.

Effect of surgical and natural menopause on proximal femur morphometry in obese women.

The purpose of this study is to determine whether there are differences in proximal femur parameters of women subjected to menopause surgically or naturally. In this study, 10 parameters belonging to proximal femur of a total of 60 women cases of whom 30 had a mean age of 55.53 ±â€¯4.57 years; body mass index, 33.06 ±â€¯4.21 kg/m2; menopause age, 48.10 ±â€¯5.92; and menopause years, 7.50 ±â€¯4.58; and who were subjected to natural menopause; and 30 women whose mean age was 56.10 ±â€¯6.87 years; body mass index, 33.33 ±â€¯3.76 kg/m2; menopause age, 48.00 ±â€¯4.64 years and menopause year, 8.10 ±â€¯7.29; who were subjected to surgical menopause, and who did not use hormone replacement, were examined by radiography. Their anthropometric measurements, body compositions, blood hormone analyses (FSH, LH, estradiol, progesterone) and bone mineral densities (femur neck, femur total, lumbar t-score) were evaluated. It was found that there was no difference between surgical and natural menopause with respect to proximal femur parameters (p > 0.05). It was also found that FSH levels were high in the surgical menopause group and there were significant differences between the groups (p < 0.040). No significant difference was found even though bone mineral density t-score tests were lower in the surgical menopause group (p > 0.05). It was found that the difference in low bone mineral density level and high FSH values in the surgical menopause group do not have a relationship with proximal femur morphometry. It was determined that even though the women did not have ovaries, there was no difference between surgical menopause women and natural menopause women with respect to proximal femur morphometry.

Influence of the long term use of a computer on median, ulnar and radial sensory nerves in the wrist region.

OBJECTIVES: Repetitive microtrauma or overuse injuries may often affect upper extremities of the long term computer users. The aim of this study was to compare sensory nerve conduction velocities (SNCV) for median, radial and ulnar nerves in the wrist of computer users with the same parameters in controls who do not use computers regularly. MATERIAL AND METHODS: Twenty one male computer users (age: mean (M) = 28.3 years ± standard deviation (SD) = 7.5 years) and 21 male control subjects (age: M±SD = 24.1±4.6 years) were recruited for the study. Limb length and the perimeters of the dominant arm and forearm were measured for each subject. The neurophysiological study consisted of measuring sensory nerve conduction of the median, ulnar and radial nerves. RESULTS: The sensory conduction velocities of both median and ulnar nerves were significantly delayed in the dominant arm of the computer users compared to the controls. In addition, sensory conduction velocity of the median nerve was significantly delayed in the dominant extremity of the computer users compared to their non-dominant extremity. CONCLUSIONS: This study shows that computer users have a tendency toward developing median and ulnar sensory nerve damage in the wrist region. Mechanism of delayed SNCV in the median and ulnar nerves may be due to sustained extension and ulnar deviation of the wrist during computer mouse use and typing. Reduced SNCV changes were more apparent on the dominant side of the median nerve. This may indicate the increased neural deficits related to an increased use of the dominant side. Further investigation is needed to determine how to reduce potential risk factors at this stage in order to prevent development of median or ulnar neuropathy in the long term computer users.

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.