A morphometric study and variations on the lumbar arteries of human fetuses.

Lumbar arteries are in series with the posterior intercostal arteries. The aim of this study has been to investigate the morphometric data on the abdominal aorta of the human fetus and define different types of origin variations of the lumbar artery. Initially, the latex solution colored with red ink was injected into the thoracic aorta. The abdominal aorta and its branches were dissected and examined bilaterally in 120 fetuses (ranging between 16 and 32 post-menstrual weeks) and the anatomic variations recorded. Fourteen fetuses with variations were studied and photographed. The origins and morphologic variations of the lumbar arteries were defined and classified. The morphological relationship of the lumbar arteries to the abdominal aorta and the length and width (diameter) of the vessels were investigated by performing measurements using a digital calliper (mm). The frequency and the types of the different variations determined in the present study have been listed. Abdominal aortic branches and Lumbar artery aneurysms are rare lesions with potentially life-threatening consequences and they are difficult to access anatomically and formidable to manage operatively. During the performance of conventional or open surgical replacement of an abdominal aortic aneurysm with prosthetic grafts, the surgeon needs precise knowledge of the anatomy of the abdominal aortic branches and immediate retroperitoneal structures. The variations on the lumbar arteries may have clinical importance. When this region is under diagnostic and/or surgical investigation using computed tomography scan or diagnostic angiography, the possibility of these variations should be take into consideration to avoid complications.

Neurotization as an alternative for restoring finger and wrist extension.

OBJECT: In cases of irreparable injuries to the radial nerve or in cases in which nerves are repaired with little anticipation of restoration of function, tendon transfers are widely used. In this study, the authors searched for a more natural alternative for selectively restoring function, with the aid of a motor nerve transfer. METHODS: Ten arms from five cadavers were used in the study. The posterior interosseous nerve and the median nerve together with their motor branches were exposed in the proximal forearm. The possibility of posterior interosseous nerve neurotization via the median nerve through its motor branches leading to the pronator teres, flexor pollicis longus, flexor digitorum profundus, and pronator quadratus muscles was investigated. The lengths of the nerves from points of divergence and their widths were measured using calipers, and the means with standard deviations of all nerves were calculated. Motor branches to the pronator teres, flexor pollicis longus, and pronator quadratus muscles were found to be suitable for neurotization of the posterior interosseous nerve at different levels and in various combinations. The motor nerve extending to the flexor digitorum profundus muscle was too short to use for transfer. CONCLUSIONS: These results offer a suitable alternative to tendon transfer for restoring finger and wrist extension in cases of irreversible radial palsy. The second step would be clinical verification in appropriate cases.

Selective restoration of motor function in the ulnar nerve by transfer of the anterior interosseous nerve. An anatomical feasibility study.

BACKGROUND: Proximal ulnar-nerve lesions have an unfavorable prognosis. The goal of the present study was to evaluate the feasibility of selective restoration of motor function of the ulnar nerve by the transfer of the anterior interosseous nerve or one of its branches to the motor branch of the ulnar nerve. METHODS: Ten cadaveric arms were used in the present study. The ulnar nerve and its motor and sensory branches as well as the anterior interosseous nerve and its branches were dissected. The widths of the motor branch of the ulnar nerve and the anterior interosseous nerve and its motor branches as well as the relevant distances from the points of divergence were measured. The axons were counted, and the distances from the end of the main anterior interosseous nerve, its motor branches, and the motor branch of the ulnar nerve to the level of the dorsal sensory branch of the ulnar nerve were measured. RESULTS: Our results indicate that the length, width, and number of axons of the branch of the anterior interosseous nerve to the pronator quadratus make it suitable for transfer to the motor branch of the ulnar nerve. The use of the main anterior interosseous nerve or its motor branches to the flexor pollicis longus and the flexor digitorum profundus is less feasible because of the need to graft a long segment and the longer distance from the level of transfer to the motor end points. CONCLUSIONS: The findings of the present study confirm the feasibility of motor-nerve transfer for reconstruction after an injury of the ulnar nerve. Nerve-grafting would be needed for injuries distal to the level of the dorsal sensory branch of the ulnar nerve.

Morphometric analyses of the development of dermis in human fetuses.

In this study, the morphometric differences of the different dermis regions during the development of the human fetus were investigated. The different dermis regions, namely, cranial, femoral and plantar (sole) parts of 40 fetuses which were between 12th-23.5th week gestation age were obtained from maternity hospital and after the routine H&E histological procedure, the measurement was performed with ocular micrometer. The first sharp increase was observed in the dermis of cranial region. It has been suggested that the thickness of the dermis is dependent on the collagen and elastic fibres, but the flexibility of the dermis is dependent on the number and the structure of the elastic fibres. The early beginning of the increase of the dermis thickness in the cranial part may be due to the effect of the cranio-caudal stimulation on the production of the collagen and elastic fibres in the embryonic term.

An investigation of the conus medullaris termination level during the period of fetal development to adulthood.

The spinal cord fills the length of the vertebral canal at the early period of intrauterine term. It is reported to extend to the level of the third lumbar vertebra at birth, because the vertebral column is growing more rapidly in the longitudinal direction than the spinal cord. The present investigation aimed to determine the changes in the termination level of conus medullaris (TLCM) from fetus to adulthood in a total of 285 individuals who had no defects in the central or peripheral nervous system, and were obtained from our Faculties of Medicine and Konya Maternity Hospital between 1992-1995. The age distribution was as follows: 36 fetuses, 20 prematures and 50 neonates, 51 children aged 1 to 7 years and 128 adults aged 15 to 68 years. In this study, for fetuses, prematures, neonates and children the TLCM was determined using ultrasonography. In addition, microdissection was used in fetuses to confirm the results obtained from the above technique. Also, magnetic resonance imaging was used in adults. During fetal life the end of the conus altered its levels from S5 to L3 vertebrae. The tip of the conus medullaris of the prematures and neonates ranged from L1 to L3 vertebrae. The tip of the conus medullaris in the children lay between the Th12 and L3 vertebrae, and in the adults it was between the Th12 and L2 vertebrae. There were slight differences between the prematures and neonates in terms of the TLCM. We concluded that there are differences in the TLCM between the age groups and therefore, especially in prematures and infants the determination of the tip of conus medullaris might be important for preventing postoperative neurological complications.

An osteometric study on humerus / Estudio osteométrico del húmero

Humerus is the longest and thickest bone of the upper limb. As a long bone, it has two epiphysis and diaphysis. In this study, we aimed to conduct morphometric measurements belonging to human humerus. This study was conducted on 60 humerus (28 right, 32 left) in collections of Necmettin Erbakan University Meram Medicine Faculty Anatomy Laboratory. Digital calipers, osteometric board and precision scales for humerus bone measurements were used. Measurements were classified as measurements of diaphysis and proximal and distal epiphysis of humerus. Each bone weight was determined. Also nutrient foramen number and localization was determined. In this study, it was determined that mean right humerus length 30.41±1.73 mm, mean left humerus length 30.04±2.39 mm. It was identified that mean right humerus weight was 115.05±28.06 g, mean left humerus weigh twas 111.63±33.34 g. In 9 humerus (15 %), supratrochlear foramen has been observed. 6 of these were oval and 3 of them were round. Nutrient foramen has not been observed in two humerus (3.3 %). Also, medium and weak correlation was identified between many parameters. We believe that the obtained data from this study may be qualities of reference for sex determination from humerus.

El húmero es el hueso más largo y grueso del miembro superior. Como un hueso largo, tiene dos epífisis y una diáfisis. En este estudio, se pretende realizar mediciones morfométricas pertenecientes al húmero humano. Este estudio se realizó en 60 húmeros (28 derechos, 32 izquierdos) en colecciones del Laboratorio de Anatomía de la Facultad de Medicina Meram,Necmettin Erbakan University, Se utilizaron calibradores digitales, tableros osteométricos y escalas de precisión para medir el húmero. Las mediciones se clasificaron como medidas de húmero proximal, corporal y distal. Se determinó el peso de cada hueso. También se determinó el número y la localización de los forámenes nutricios. La longitud media del húmero derecho fue de 30,41 ± 1,73 mm y la del húmero izquierdo fue de 30,04 ± 2,39 mm. El peso medio del húmero derecho fue 115,05 ± 28,06 g y el izquierdo 111,63 ± 33,34 g. En 9 húmeros (15 %), se observó un foramen supratroclear, seis de ellos eran ovales y tres redondos.No se observó foramen nutricio en dos húmeros (3,3 %). Además, se identificó una correlación media y débil entre varios parámetros. Creemos que los datos obtenidos de este estudio pueden ser de referencia para la determinación del sexo de un individio a partir del húmero.

Complete ossification of the superior transverse scapular ligament in an Turkish male adult / Osificación completa del ligamento escapular superior transverso en un hombre adulto de Turquía

Scapula has three margins and angles and located posterolateral of thorax. One of the anatomical structures of scapula is suprascapular notch located medial to coracoid process base. Suprascapular notch can be seen in different shapes and depths. Suprascapular notch is surrounded by transverse scapular ligament which is a short and strong ligament. Suprascapular notch creates an osteofibrosis passage with this structure within suprascapular nerve passes. It has been reported that this osteofibrosis structure can intirely or partially ossify. All lesions of nerves occured in course as result of exposure to compression, tension and bending are called entrapment neuropathy. Like other peripheral nerves, suprascapular nerve can be exposed to compression while passing suprascapular notch. As a result of this compression suprascapular entrapment neuropathy may occur. There are direct trauma, repetitive microtrauma, neurit, progressive compressive lesions in suprascapular entrapment neuropathies etiology. A suprascapular notch taken foramen shape can be a predisposing factor to entrapment neuropathy. In the retrospective screening from Necmettin Erbakan University, Meram Medical Faculty, Department of Radiology archive, a male patient at age 68 with suprascapular notch variation has been detected. This patient's right suprascapular notch had became foramen by an osseous bridge. Diameters of foramen has been measured as 5.27 mm transverse 6.48 mm vertical. We believe having detailed knowledge of suprascapular notch is significant as a possible course of back and shoulder pain is entrapment of suprascapular nerve in suprascapular notch causing nerve paralyses, and it will give a right direction to clinicians in surgical practices.

La escápula tiene tres márgenes y tres ángulos, y se encuentra en la región posterolateral del tórax. Una de las estructuras anatómicas de la escápula es la incisura supraescapular situada medial a la base del proceso coracoides. La incisura supraescapular puede tener diferentes formas y profundidad. Está rodeada por el ligamento escapular transverso, un ligamento corto y fuerte. Con esta estructura, crea un pasaje osteofibroso por el cual pasa el nervio supraescapular. Se ha reportado que esta estructura osteofibrosa se puede osificar completa o parcialmente. Todas las lesiones de los nervios ocurren en su trayecto como resultado de la exposición a compresión, tensión y flexión, lo que se denomina neuropatía por atrapamiento. El nervio supraescapular puede estar expuesto a compresión al pasar por la incisura supraescapular, generando neuropatía por atrapamiento. Su etiología puede ser por traumatismo directo, microtraumatismo repetitivo y lesiones compresivas progresivas. Una incisura supraescapular de forma oval puede ser un factor predisponente para la neuropatía por atrapamiento. En un estudio retrospectivo realizado en la Universidad Necmettin Erbakan, Facultad de Medicina de Meram, Departamento de archivo de Radiología, se observó la imagen de un varón de 68 años con variación en la incisura supraescapular derecha, la cual se transformó en un foramen por un puente óseo. Los diámetros del foramen fueron 5,27 mm transversales y 6,48 mm verticales. Creemos que el conocimiento detallado de la incisura supraescapular es necesario en el diagnóstico y posible curso de dolor del hombro, debido al atrapamiento del nervio supraescapular en la incisura y la posible parálisis nerviosa, dando una guía a los clínicos en las prácticas quirúrgicas.

An investigation of the conus medullaris and filum terminale variations in human fetuses.

The morphologic structure of the conus medullaris and filum terminale was investigated by dissection in 123 human fetuses, obtained from Selçuk University, Faculty of Medicine and Maternity hospital of Konya between 1992-1995. In 78 fetuses, the conus medullaris and filum terminale had a normal morphologic aspect, whereas there was a slight depression or groove formation in the closure region of the caudal neuropore in 45 fetuses. In 15 fetuses, important malformations of the cranium and vertebral column were observed. The morphologic aspects of the conus medullaris in 30 fetuses were abnormal in shape and position, among them 24 fetuses had an abnormal filum terminale (grooved, depressed, thickened or duplicated) whereas it was normal in 6. Deficiency of closure of the caudal neuropore was considered to have a negative effect on the fetal development of the filum terminale.

An alternative method for restoring opposition after median nerve injury: an anatomical feasibility study for the use of neurotisation.

Opposition, one of the most important functions of the hand, is lost or impaired after median nerve injury. Complete recovery does not always occur after treatment, and various techniques of opponensplasty are used for restoring opposition. This study was performed in order to develop an alternative method for selective restoration of thenar muscle function. Ten arms from 5 cadavers were used. The median nerve with its thenar motor branch (Tb) and the anterior interosseous nerve with its motor branch to pronator quadratus (PQb) were prepared in the distal forearm. The mean widths and the number of myelinated fibres of these nerves were: PQb 1.3+/-0.10 mm, Tb 1.4+/-0.12 mm and PQb 912+/-88 mm, Tb 1020+/-93 mm. The minimum necessary distance from the distal flexor crease of the wrist for neurotisation of the Tb by the PQb was 60+/-5.41 mm. It was concluded that PQb-Tb neurotisation would be possible anatomically. The advantages are that motor function is reestablished with a motor nerve, the diameters and the number of myelinated fibres of both nerves are similar, the loss of function after denervation of the pronator quadratus is slight and opponensplasty still remains as a final option.

Maxillary-to-petrous internal carotid artery bypass: an anatomical feasibility study.

The possibility for maxillary artery (MA) to petrous internal carotid artery (ICA) bypass was investigated. Five adult cadavers were dissected bilaterally. After zygomatic arch osteotomy, the coronoid process was sectioned at its base. An extensive infratemporal craniotomy was performed at the level of foramina ovale, rotundum and spinosum. The petrous portion of the ICA was exposed by drilling away the floor of the middle fossa, posterior to the foramen ovale and medial to the foramen spinosum. The MA was identified medial to the infratemporal crest and was followed in the pterygopalatine fossa, then transected at the origin of the infraorbital artery. The MA graft was brought posteromedially to reach the petrous ICA. The mean caliber of the MA before the origin of the infraorbital artery was 2.54+/-0.31 mm, 2.76+/-0.14 mm at the site of anastomosis, and 3.46+/-0.32 mm after giving off the middle meningeal artery. The average length of the MA between the middle meningeal artery and the infraorbital artery was 43.4+/-2.35 mm, and up to the site of anastomosis was 37.64+/-1.68 mm. We conclude that the length and diameter of the MA are sufficient for a tension-free anastomosis between MA and petrous ICA, and such a procedure could be used in the treatment of patients with tumors of the infratemporal fossa invading the high cervical ICA.

Ocular and periorbital anthropometric measurements in term Turkish newborns.

This study was conducted in an effort to determine the normal landmarks in the eyelids and eyebrows of newborns and the relationships between them. We also correlated all measurements with gender and head circumferences. The anthropometric measurements were performed on 86 normal term newborns (40 males and 46 females) in the first 48 hours after delivery. There was no significant difference between either sex, or between the right and left eyes. In contrast, a statistically significant positive correlation was found between the head circumference and the horizontal fissure length (r = 0.42, p < 0.01). In addition, a significant correlation was found between the upper eyelid crease distance and the horizontal and the vertical fissure lengths (r = 0.27, p < 0.01; r = 0.22, p < 0.05, respectively). The results indicate that the normal eyelid crease location may be used as a landmark for guidance to plan surgical and reconstructive procedures.

The relationship between the lumbosacral enlargement and the conus medullaris during the period of fetal development and adulthood.

The spinal cord is situated within the vertebral canal by the third month of intrauterine life. The spinal cord possesses two symmetrical enlargements, which constitute the segments of the plexuses: the cervical enlargement for the brachial plexus and the lumbosacral enlargement for the lumbar and sacral plexus. In our study, we aimed to investigate the relationship between the termination level of the lumbosacral enlargement (TLLE) and that of the conus medullaris (TLCM) during the period of fetal development and adulthood. We used a total of 75 cases: 25 fetuses (male: 16, female: 9) whose crown-rump length ranged between 90-190 mm, 25 premature and full-term neonates (male: 17, female: 8) whose post-menstrual ages ranged between 33-55 weeks, and 25 adults (male: 12, female: 13) aged between 22-72 years. The dissection technique for fetuses, ultrasonography for premature and full-term newborns, and magnetic resonance imaging (MRI) for adults were used to determine lumbosacral enlargement and TLCM. The differences between the TLCM and the termination level of the largest part of the transverse diameter of the lumbosacral enlargement were investigated. The differences between the TLLE and TLCM were found in different ratios from the period of fetal development to adulthood. Therefore, during medical treatment and surgical procedures this should be taken into account to avoid complications.

The possibility of deep peroneal nerve neurotisation by the superficial peroneal nerve: an anatomical approach.

Neurotisation involves transfer of nerves for the restoration of function following injury. A number of nerves have been used in different part of the peripheral nervous system. This study was undertaken to develop a practical and relatively safe surgical approach to the treatment of L4 root lesion's. We examined the effectiveness and safety of neurotisation of the deep peroneal nerve and its branches by the superficial peroneal nerve. Twelve legs of dissected cadavers provided for teaching purposes in the anatomy laboratory were used to display the common peroneal nerve and its branches. Each branch was measured using calipers and analysed to investigate the possibility of neurotisation of the deep peroneal nerve by the superficial peroneal nerve and its branches. It was found that of the measured branches, transposition was possible between those to peroneus longus and tibialis anterior on the basis of their diameter and length. In recent decades, advances in microsurgical reconstruction and understanding of the microanatomy have played major roles in improving the results of surgical treatment of nerve injuries. There is a need for further experimental studies on the feasibility of this surgical approach.