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It was aimed to reveal whether the positions and dimensions of the extrinsic and intrinsic muscle tendons related to the hallux around the first metatarsal bone are affected by the severity of hallux valgus (HV) and whether tendon positional changes and tendon sizes affect each other. In formalin-fixed 46 feet, three HV angle subgroups (normal, mild and moderate/severe ) were defined. Width, thickness and cross sectional area (CSA) of tendons of the extensor hallucis longus (EHL) and brevis (EHB), abductor hallucis (AH) and flexor hallucis longus (FHL) were measured. On the clock model created in coronal plane, positional variations of each tendon were indicated. In the moderate-severe HV group, thickness and CSA of the EHB, width and CSA of the AH were smaller, compared to mild HV. Width and CSA of the FHL were smaller in moderate/severe HV than in the normal. Regardless of HV, the width and CSA of the FHL was greater in cases where the FHL located more lateral, and the width of both FHL and AT were greater in cases where AH located more plantar. The smaller tendon size of two intrinsic (one plantar and one dorsal) and one extrinsic muscle in the moderate/severe HV group indicates that the changes reflected in the tendons are more pronounced in the case of high HV severity, and the changes are not limited to the tendons on just one side of the foot. The possible biomechanical effects of AH, FHL and EHB tendon dimensional weakness may be important when planning surgery for moderate/severe HV cases.

Human tissues in gross anatomical archives with long years of postmortem delays are considered suboptimal relative to recently fixed materials for neuroanatomical tracing studies, yet efficacy of neuroanatomical tracing on archival fetal tissues largely unexplored. We aimed to explore the suitability of human archival tissue in neuroanatomical tracing with lipophilic carbocyanine dyes.We used crystal and paste forms 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) and analogues for neuroanatomical tracing on different peripheral nerves in 15-18-year archival old formalin-fixed human fetuses. We employed bright-field, fluorescent and confocal microscopy to visualize the peripheric nerve traces, spinal cord and vibratome cut sections. Fluorescent signal of the dyes on epineurium and on axonal membranes were visualized under fluorescence and confocal microscopes and performance of the dye diffusion was assessed by semi-quantitative image analysis.We followed up seven lipophilic dye embeddings in 16-28 gestational week-old human fetuses (n = 4) with 16.75 ± 1.29-year postmortem delay. The mean distance of distally moved carbocyanine dye diffusion measured on epineurium was detected as 25.11 ± 9.1 mm.Based on the results of 13 distinct studies performed neuroanatomical tracing with human tissues in the immediate postmortem hours or days, average traced distance was 16.32 ± 15.95 mm, and a 95% confidence interval lower limit of 4.9 mm and upper limit of 27.73 mm. The tracing distances we observed in our current study fall entirely within this confidence interval. To our awareness, this is the first report to demonstrate that specific neuroanatomical tracing presented in axonal membrane level on peripheral nerves is possible on gross anatomical repositories.

No prior publication studying the biomechanical and histological properties of cadavers fixed with Logan or modified Logan solution (MLS) was found in the literature. It was aimed in this study to compare MLS fixation and other cadaver preservation procedures regarding the use in basic histological studies, anatomy education and surgical trainings. This study was placed on 35 male 17-week-old Wistar Albino rats. MLS fixated tissues were systematically compared with 10% formalin (F10), saturated salt solution (SSS), Thiel and frozen/thawed (FT) tissues. Organoleptic (color, appearance, flexibility, odor, etc.), morphometric (e.g. length, width and cross-sectional area), biomechanical (Young's modulus, stiffness, maximum load, etc.) and histological (tendon and muscle fiber integrity, nuclear prominence, blur in microscopy, etc.) analyses were conducted. Organoleptic properties of Thiel and SSS fixated muscles and tendons were better preserved than F10 and MLS. No significant difference was observed in gross morphometric properties (e.g. length, width and cross sectional area) following any of the cadaver and tissue preservation techniques. MLS and F10 was observed to increase the stiffness, Young's modulus and maximum load parameters of the tendons. Thiel and SSS fixated tendons had similar mechanical properties to fresh and FT tendons. No effect of fixation solutions on tendons is observed in the histological analysis regarding fiber integrity, nuclear prominence, blur in microscopy, shrinkage of tissues. Thiel solution was observed to distort fiber integrity, nuclear prominence and blur the microscopy of muscle tissue. Thiel and SSS fixated muscles and tendons were observed to absorb more stain with Masson's trichrome staining and appear as darker red. No muscle and tendon shrinkage due to fixative solutions was observed with our fixation method. Pondering the organoleptic (color, appearance, consistency, odor, etc.) and biomechanical analyses (stiffness, Young's modulus, etc.), Thiel and SSS fixed cadavers are more suitable for purposes as surgical trainings and development of new surgical procedures. However, the change in the micro-anatomical structure of the muscles, especially with the Masson's trichrome staining, caused by these two solutions should not be overlooked.

A replaced right hepatic artery (RHA) arising from the superior mesenteric artery and an interlobar parenchymal bridge over the sagittal fissure have been observed on a 64-year-old formalin-fixed male cadaver in the anatomy laboratory. As we had followed a detailed segmental anatomy, we encountered an arterial distribution of segment IV featuring a different pattern from the literature so far. According to our observations, the segment I is supplied by both left (LHA) and middle (MHA) hepatic arteries; the segments II and III are supplied by the LHA while the segment IV is supplied by both the MHA and replaced RHA. The segments V-VIII are supplied only by the replaced RHA. The case emphasizes the importance of arterial variations of liver in terms of the surgical procedures during the liver transplantation, hepatic resections, hepatic tumours, and etc. Our discussion focuses to the arterial supply of the segment IV and possible complications it may cause during/after the liver operations.

This study is intended to obtain the algebraic growth dynamics of the gracilis in fetuses and determine the variations of neurovascular pedicle(s) of the gracilis, to aid infant surgeries. Forty fetuses (19 males and 21 females) were included in the study. Gestational mean age of the fetuses was 22.40 ± 2.67 (range, 18-28) weeks. Numerical values were obtained using a digital caliper and a digital image analysis software. Linear functions for the surface area, width, anterior, and posterior margin lengths of the gracilis were calculated, respectively, as: y = -289.307 + 20.501 × age (weeks), y = -7.113 + 0.622 × age (weeks), y = -24.421 + 3.434 × age (weeks), and y = -24.397 + 3.314 × age (weeks). In addition, length and width of the gracilis tendon were calculated as y = -6.676 + 0.934 × age (weeks) and y = -0.732 + 0.074 × age (weeks), respectively. Parameters of the gracilis had no statistically significant difference regarding side and sex (P > 0.05). In all the specimens, the gracilis was innervated by the anterior branch of the obturator nerve. Blood supply of the gracilis was identified to be derived from 1 single artery in 38 sides of total 80 (47.5%), from 2 arteries in 36 (45%) and from 3 arteries in 6 (7.5%). In 74 sides (92.5%), the nerve was superficial to the main artery, whereas in 6 sides (7.5%), it was deeper. The data of the present study could be beneficial for surgeons in infant surgeries to treat conditions such as obstetrical brachial plexus paralysis, facial palsy, or anal incontinence. Linear functions can be utilized to better evaluate the growth course of the gracilis in fetuses and to predict the dimensions thereof. Additionally, comprehending the structure and recognizing the variations of the gracilis nerves and arteries can help to protect the neurovascular pedicle(s) of the gracilis during the operations.

Background: In neonatal and early childhood surgeries such as meningomyelocele repairs, closing deep wounds and oncological treatment, tensor fasciae lata (TFL) flaps are used. However, there are not enough data about structural properties of TFL in foetuses, which can be considered as the closest to neonates in terms of sampling. This study’s main objective is to gather data about morphological structures of TFL in human foetuses to be used in newborn surgery. Materials and methods: Fifty formalin-fixed foetuses (24 male, 26 female) with gestational age ranging from 18 to 30 weeks (mean 22.94 ± 3.23 weeks) were included in the study. TFL samples were obtained by bilateral dissection and then surface area, width and length parameters were recorded. Digital callipers were used for length and width measurements whereas surface area was calculated using digital image analysis software. Results: No statistically significant differences were found in terms of numerical value of parameters between sides and sexes (p > 0.05). Linear functions for TFL surface area, width, anterior and posterior margin lengths were calculated as y = –225.652 + 14.417 × age (weeks), y = –5.571 + 0.595 × age (weeks), y = –4.276 + 0.909 × age (weeks), and y = –4.468 + 0.779 × age (weeks), respectively. Conclusions: Linear functions for TFL surface area, width and lengths can be used in designing TFL flap dimensions in newborn surgery. In addition, using those described linear functions can also be beneficial in prediction of TFL flap dimensions in autopsy studies.

PurposeThe main objective of the study was to examine the use of teres major (TM) as a flap in the pediatric surgeries from an anatomical perspective by: (1) revealing the growth dynamics of the developing TM; (2) assessing the possible interconnecting structures between TM and latissimus dorsi (LD); (3) exposing the innervation patterns of TM in human fetuses.MethodsStudy was conducted on 50 fetuses (26 females and 24 males), on a mean gestational age of 22.863.21 (range 18-30) weeks. All the measurements were collected with a digital caliper and a digital image analysis software. Additionally, structural relations between TM and LD were examined in detail and further classified.ResultsNo significant difference of side and sex was detected on TM measurements (p>0.05). Linear functions for the surface area, width, length of the superior and inferior margins of TM were detected as follows: y=-257.142+18.334xage (weeks), y=-5.497+0.545xage (weeks), y=-1.621+1.068xage (weeks), and y=-2.147+1.284xage (weeks), respectively. As classified in five types, a number of 33 muscular or tendinous connections between TM and LD were detected. Musculo-tendinous slips from TM to triceps brachii (TB) were evident in four sides. Innervation of TM was observed to be providing by the lower subscapular nerve in all the cases.Conclusion p id=Par4 First, linear functions, representing the developing fetal morphometry obtained by our study can be adapted for estimating the morphometric of this muscle in early childhood. Besides, acknowledging the diverse appointments of TM with the surrounding muscles such as LD and TB may facilitate the prevention of neurovascular structures and the application of surgical procedures during tendon transfers. In brief, our findings are highly potent to bring the attention of pediatric surgeons.

OBJECTIVES: This study aimed to compare the right and left sides of the carotid foramen (CF) to determine its precise location according to certain anatomical landmarks. MATERIALS AND METHODS: Twenty human dry skulls were included in the study. A digital caliper and a digital image analysis software were used to obtain direct anatomical numerical values. Then, the same parameters on dry skulls were assessed with computed tomography (CT). RESULTS: CF was found to be round shaped (62.5%), oval shaped (32.5%), and tear-drop shaped (5%). In all cases, the position of CF was seen as just postero-laterally of the foramen lacerum. According to the jugular foramen, CF was seen to be anterior in 85% and antero-medial in 15% of the cases. Regarding the morphometric values of the surface area, the length and width of CF were observed to be 37.86±11.24 mm(2), 8.02±1.09 mm, and 6.86±0.90 mm at direct anatomical measurements and 39.69±10.07 mm(2), 7.89±1.14 mm, and 6.41±0.90 mm at CT, respectively. The angles between the supramastoid crest-CF-zygoma root and the supramastoid crest-CF-mastoid process were determined as 37.11±6.87° and 42.22±6.40° at direct anatomical measurements and 36.59±4.94° and 43.71±4.55° at CT, respectively. CONCLUSION: A significant difference in sides was not observed in relation with the numerical data of CF obtained from CT or from direct anatomical measurements of dry skulls. Moreover, a significant difference was not found between radiological and direct anatomical measurements. Therefore, precise radiological assessment of this region by an experienced neuroradiologist may be assumed as a fundamental need for successful surgeries of the skull base, in addition to thorough anatomical knowledge of neurootologists and neurosurgeons.

Objectives: To evaluate the origin, distribution pattern, branches, and neighboring structures of the iliolumbar artery (ILA) concerning the anterolateral surgical approaches to the spine. Methods: This study was performed in the Anatomy Department of Medical School, Mersin University, Mersin, Turkey between 2014 and 2015. Pelvises of 11 male formalin-fixed human cadavers were dissected by anterior and posterior approaches under surgical microscope. The origins, distribution patterns, calibers, and distances to certain structures were measured. Results: The ILA was found as a single trunk on 17 sides arising either from the IIA (12 sides, 70.6%) or the PT (5 sides, 29.4%). The average caliber of those originated from the posterior trunk was significantly larger ( p =0.010). The ILA started as a single trunk in 17 sides, while its lumbar and iliac branches separately originating from different arteries in 4 sides. The close relation of the posterior rami of both the lumbar and iliac branches with transverse process and spinal nerve were noted. Conclusion: Findings suggest that the ILA and its branches may have different and significant patterns, which may be crucial to consider during certain surgical procedures, such as far lateral disc herniation and posterior pelvic fixations. Saudi Med J 2016; Vol. 37 (4): 457-460 doi: 10.15537/smj.2016.4.12665 How to cite this article: Koc T, Gilan IY, Aktekin M, Kurtoglu Z, Dagtekin A, Aytac G, et al. Evaluation of the origin and branching patterns of the iliolumbar artery and its implications on pelvic and vertebral surgery. Saudi Med J 2016; 37: 457-460.

In human anatomy, piriformis muscle and peripheral nerve variants may represent an unrecognized etiology. These variations in the gluteal region may cause entrapment of the sciatic nerve and induce to the piriformis syndrome. We present a case of accessory piriformis muscle accompanying to high divisions of sciatic nerve, unusual course of nerves and fusion of the piriformis muscle with gluteus medius in the left gluteal region of a 64-year-old male cadaver. The nerves which are originating from dorsal part of the sacral plexus, inferior gluteal nerve, common fibular part of the sciatic nerve and posterior femoral cutaneous nerve are located between the piriformis and accessory piriformis muscles make this case the most interesting of its kind. Awareness of these variations may prove to be useful for surgeons during the surgery of the gluteal region and the clinician when treating patients with buttock pain. Additionally, the possible role of aberrant anatomical variations of the related region in causing piriformis syndrome must be taken into consideration as one of the contributing factors.

The main objective of the study was to investigate the morphometric properties of the stapedial tendon (ST) for pediatric otosurgeons and anatomists. The present study was placed on 15 fetuses (8 females, 7 males) aged from 20 to 30 weeks of gestation (at mean, 24.27 ± 3.24 weeks) using the collection of the Anatomy Department of Medicine Faculty, Mersin University. All measurements were obtained with a digital image analysis software. In terms of male/female or right/left comparisons, no statistically significant difference was found in relation with the numerical data of ST. The surface area, length, and width of ST were detected as follows: 0.61 ± 0.15 mm2, 1.27 ± 0.30 mm, and 0.45 ± 0.08 mm, respectively. The absence of ST was observed in two fetuses with and without severe malformations. In another fetus with cleft lip and polydactyly, multiple abnormalities were bilaterally identified in the middle ear: (1) the absence of the incudostapedial joint and (2) the presence of an abnormal tissue attaching to the stapes. The abnormal tissue was determined to be irregular dense connective tissue using light microscope and electron microscope. Our findings showed that ST did not proportionally grow according to increasing gestational weeks. In the light of the numerical data, we thought that similar to stapes, ST attains the adult size in the fetal period. As ST anomalies may accompany severe malformations (e.g., cleft lip, polydactyly or syndactyly) that can be easily detected on observation by clinicians, we suggest that the detailed examination of middle ear in newborns should be taken into account for early diagnosis of conductive hearing loss to prevent any management delays.

Objectives The main aim of the study was to examine the development and course of the facial nerve within fetal temporal bones from an anatomical and neuro-otological perspective. Methods The study was conducted on 32 temporal bones from obtained fetuses (7 females, 9 male), on a mean gestational age of 26.75 ± 4.36 (range, 20–34) weeks from the collection of the Anatomy Department of Medicine Faculty. All the measurements were collected with a digital image analysis software. Results Neither male/female nor right/left significant differences were observed in relation with the algebraic data of the segment lengths and angles of the facial nerve (p > 0.05). Linear functions for meatal, labyrinthine, tympanic, and mastoid segment lengths of the facial nerve were calculated as: y = −1.206 + 0.200 × Age (weeks), y = −1.868 + 0.153 × Age (weeks), y = −2.327 + 0.325 × Age (weeks), and y = −1.507 + 0.246 × Age (weeks), respectively. In addition, linear functions for first and second genu angles were calculated as: y = 105.475–0.117 × Age (weeks) and y = 140.446–0.042 × Age (weeks), respectively. Conclusion The regression equations and the scatter plot with increment curve, representing the growth dynamics of the facial nerve can be used for estimating its lengths and for understanding its development. The data suggest that there is a dramatic change transition from fetal life to the gathered data of adulthood in the length of meatal and mastoid segments as well as in the second genu angle; in addition, there is a partial change in the length of labyrinthine and tympanic segments as well as in the first genu angle.

The CHARGE syndrome characterized by coloboma, heart defects, atresia of the choanae, retarded growth, genitourinary hypoplasia, and ear anomalies is one of the rare syndromes. Although certain clinical issues (scapular winging, sloping shoulder, Sprengel's deformity, kyphosis and scoliosis) which could be related to abnormalities in musculoskeletal structures of the neck and shoulder have been identified in CHARGE syndrome, data on details of muscle anomalies seem to be quite limited in the literature. In this case report, bilateral multiple muscular abnormalities (agenesis of the trapezius, presence of the rhombo-atloid muscle, and presence of the bipartite rhomboid minor with superficial and deep parts) was presented in a fetus cadaver with atypical CHARGE syndrome to attract the attention of clinicians for definitive diagnoses and surgical reconstruction of the shoulders deformity such as scapular winging and Sprengel's deformity. By considering the previous studies, we propose that the absence of the trapezius, as well as the other muscle abnormalities around the neck and shoulder, should be revised as being a component of CHARGE syndrome.

Human anatomy education at undergraduate level has become rather complicated as in many other disciplines due to rapid development of new education-training methods such as use of audiovisual material, internet based learning, virtual reality simulation, and multimedia learning which creates some sort of educational complexity. The mode of education and training which is an interaction period between the instructor and the learner may have a significant impact on the attitude of the students towards a spesific course. Hence, it is critical to identify the attitute of the students regarding the human anatomy education while considering their demographic characteristics. In accordance with this purpose a questionnaire was implemented to 316 students who took the human anatomy course in the Near East University; 198 of the students were female and 118 were male. The 39.2% of the participants of the study had only theoretical sessions while 60.8% had theoretical and practical sessions of anatomy. The students’ attitude were assessed by means of questionnaire that has been developed by Bahceci in 2006; it included 24 questions for the attitude towards the human anatomy course while 14 questions formed the demographic part of the questionnaire. The students of the faculty of medicine, faculty of dentistry, faculty of pharmacy, and faculty of health sciences were included in the study. PASS (Power and Sample Size) Version 15.0 was used for calculating the sample size while two step systematic strafied sampling method was used for the sample selection. Level of significance was set at 0.05. The results showed that two of the subscales namely involvement and preconception as well the total score were statistically significantly higher for the group who had both theoretical and practical anatomy sessions compared to the ones who had anatomy course only through the theoretical lectures. Keywords: Anatomy, Health Sciences, Student Attitude, Teaching and Learning

A replaced right hepatic artery (rRHA) arising from the superior mesenteric artery and an interlobar parenchymal bridge over the sagittal fissure of liver have been observed on a 64 year old formalin-fixed male cadaver in the anatomy laboratory. As we followed a detailed segmental anatomy, encountered an arterial distribution on the segment IV featuring a different pattern from the literature so far. According to our observations, the segment I is supplied by both left (LHA) and middle (MHA) hepatic arteries; the segments II and III are supplied by the LHA while the segment IV is supplied by both the MHA and rRHA. The segments V-VIII are supplied only by the rRHA. Our case emphasizes the importance of arterial variations of liver once again in terms of the surgical procedures during the liver transplantation, hepatic tumors, and etc. Our discussion particularly focuses to the arterial supply of the segment IV and possible complications it may cause during/after the liver operations.

Bilateral large variant veins were encountered in the lower extremity. It was aimed to identify the structural characteristics of this rare case and then, regarding the structural features, to overview its formation process and denomination. During the routine dissection of a 93-year-old male cadaver, bilateral large variant veins were found at the thigh. Valves of the veins were examined and evaluated together with the vascular wall histology. The variant vein was loosely attached to the sciatic nerve by fibrous tissue and had anastomoses with the popliteal vein in the popliteal fossa on each side. The popliteal veins were hypoplastic on both sides. The right variant vein was passing through the fibers of the adductor magnus muscle 56.2 mm above the adductor hiatus, which corresponds to the third perforating branch of deep femoral vein. The left one was turning to the front over the adductor magnus muscle, at the lower border of quadratus femoris muscle. The left variant vein was corresponding to the descending branch of the medial circumflex femoral vein. Both variant veins had one incomplete and three well-developed valves. In accordance with the findings, the variant vein was concluded to be an embryonic remnant, rather than an acquired one subsequent to any obstruction of the femoral vein. Regarding their connection with the popliteal vein but not with the internal iliac vein, both variant veins were denominated as “lower type persistent sciatic vein”. Such a variation would be important with respect to the risk of complication during popliteal sciatic nerve blockade.