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Abstract
Chronic pain after inguinal hernia repair with prosthetic meshes is recorded in some patients. Although the exact etiology of the pain is not fully understood, it can be related to the trauma to the regional nerves. It is possible to involve these nerves by injuring, suturing, stapling, tacking or compressing them during the operation. Therefore, a delicate surgical approach to the inguinal floor with correct identification of three nerves is necessary for patient comfort at early and late postoperative period. We herein report a surgical view of an inguinal floor which are very rich of neural structures in a patient undergo an elective inguinal hernia repair. The number of the main nerve bundles was excessive, and they were thicker than generally met. This kind of anatomic variations may create a difficulty for repair with prosthetic material. The identification of the nerve structures was hard at first sight and the correct identification was only made by consulting the surgical picture with a senior anatomist.
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Affiliation(s)
- H. Kulacoglu
- Department of Surgery Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
- Department of Surgery Ankara Hernia Center, Ankara, Turkey
| | - T. Sen
- Department of Surgery Ankara University School of Medicine, Department of Anatomy, Ankara, Turkey
| | - I. Ozyaylali
- Department of Surgery Ankara Hernia Center, Ankara, Turkey
| | - A. Elhan
- Department of Surgery Ankara University School of Medicine, Department of Anatomy, Ankara, Turkey
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Idilman R, Cinar K, Seven G, Bozkus Y, Elhan A, Bozdayi M, Yurdaydin C, Bahar K. Hepatitis B surface antigen seroconversion is associated with favourable long-term clinical outcomes during lamivudine treatment in HBeAg-negative chronic hepatitis B patients. J Viral Hepat 2012; 19:220-6. [PMID: 22329377 DOI: 10.1111/j.1365-2893.2011.01542.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The aims of this study were to assess hepatitis B surface antigen (HBsAg) seroconversion and to determine its impact on the natural course of the disease in patients with HBeAg-negative chronic hepatitis B (CHB) during lamivudine (LMV) treatment. A total of 183 consecutive patients with HBeAg-negative CHB who were treated with LMV were included in the study. Data were retrospectively collected from outpatient visit charts. The primary endpoint was HBsAg seroconversion to anti-HBs. The secondary endpoint was to determine the development of cirrhosis. Loss of HBsAg was confirmed in 10 patients and seroconversion to anti-HBs in nine patients during LMV treatment or after its discontinuation. HBsAg seroconversion was achieved on-treatment in four patients after a median treatment duration of 30 months and off-treatment in the remaining five patients in a median 61 months after LMV discontinuation. The cumulative probability of HBsAg seroconversion increased from 0.6% at 1 year and 1.9% at 5 years to 21.5% at 10 years of LMV during and after LMV treatment. HBsAg clearance was preceded by undetectable serum hepatitis B virus (HBV) DNA. The majority of the patients responding to treatment had undetectable HBV DNA levels at 24 weeks of treatment. The cumulative probability of LMV resistance increased from 2.2% at 1 year to 37.3% at 5 years. No baseline parameter predicting either HBsAg seroconversion or the emergence of LMV resistance was identified. None of the patients with HBsAg seroconversion experienced virological breakthrough or disease progression during the follow-up period. These results indicate that HBsAg seroclearance can occur in patients with HBeAg-negative CHB under LMV therapy and predicts better clinical outcome.
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Affiliation(s)
- R Idilman
- Department of Gastroenterology, Ankara University, Ankara, Turkey.
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Ergül Z, Kulaçoğlu H, Sen T, Esmer AF, Güller M, Güneri G, Elhan A. A short postgraduate anatomy course may improve the junior surgical residents' anatomy knowledge for the nerves of the inguinal region. Chirurgia (Bucur) 2011; 106:599-603. [PMID: 22165058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND AIM Inguinal hernia repair is one of the most common operations in a junior surgical resident's postgraduate training. Short recall courses can improve junior residents' anatomy knowledge and results in better surgical outcomes. We aimed to investigate the effect of a short course on anatomical competency during inguinal hernia repairs. METHODS During the first 25 inguinal hernia repairs, two junior residents were asked to identify iliohypogastric, ilioinguinal, and genital branch of genitofemoral nerves. Then, the residents were given a short recall course by anatomists. Afterwards, the participants were taken into an in-vivo anatomy test again. The same parameters were recorded in another 25 inguinal hernia repairs. In addition to the nerve identification records, case characteristics [body mass index (BMI < or = 25 vs. >25), hernia type (indirect vs. direct), and anesthesia used (general or regional vs. local)] were recorded. RESULTS Anatomy education had a clear impact on the correct identification rates for the iliohypogastric and ilioinguinal nerves. The rates increased from 70% to 90% and above. Correct identification rate for the three nerves together significantly increased from 16 to 52% following anatomy education (P = 0.006). All three nerves were identified with significantly higher success rates after anatomy education. The increase in the success rate for identification of the genital branch of genitofemoral nerve was 4-fold. CONCLUSIONS Short anatomy courses in specific subjects for junior surgical residents given by formal anatomists may be effective during postgraduate education. The benefit obtained in the present study for the inguinal region nerves may be expanded to more important anatomical structures, such as the recurrent laryngeal nerve in a thyroidectomy, or more complex subjects.
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Affiliation(s)
- Z Ergül
- Department of Surgery, Diskapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
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4
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Dogan S, Demirer S, Kepenekci I, Erkek B, Kiziltay A, Hasirci N, Müftüoglu S, Nazikoglu A, Renda N, Dincer UD, Elhan A, Kuterdem E. Epidermal growth factor-containing wound closure enhances wound healing in non-diabetic and diabetic rats. Int Wound J 2009; 6:107-15. [PMID: 19432660 DOI: 10.1111/j.1742-481x.2009.00584.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This study was designed to elucidate the in vivo efficacy of epidermal growth factor (EGF) on wound healing in non diabetic and diabetic rats. METHODS Ninety-six male Wistar-Albino rats were randomly divided into six groups. Saline-moistened gauze, pure gelatin or EGF in gelatin-microsphere dressings were used in a dermal excision model in both normal and streptomycin-induced diabetic rats. Wound healing was evaluated on day 7 and 14. Reduction in wound area, hydroxypyroline content and tensile strength of the wound were evaluated in each rat. Tissue samples taken from the wounds were examined histopathologically for reepithelialisation, cellular infiltration, number of fibroblasts, granulation and neovascularisation. RESULTS On day 7, the use of EGF-containing dressing was observed to reduce the wound area better when compared with the other dressings tested. This effect was significant in normal rats rather than diabetic rats. The difference in reduction of wound area did not persist on day 14. No significant effect on hydroxyproline content of the wound was found with EGF-containing dressing in either normal or diabetic rats. There was a statistically significant increase in tensile strength values of EGF-applied non diabetic rats over the 14 day period. An increase in tensile strength was prominent in also EGF-applied diabetic rats on day 14. Histological examination revealed higher histopathologic scores in EGF-applied diabetic and non diabetic rats. CONCLUSION These findings implicate that use of EGF in gelatin-microsphere dressings improves wound healing both in normal and diabetic rats.
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Affiliation(s)
- S Dogan
- Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey
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5
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Abstract
Endoscopic endonasal transsphenoidal approach to the sellar region yields an alternative to classical microsurgical approaches. Endoscopes provide images that differ from microscopic view. This study aimed to highlight surgical landmarks and their anatomical relationships for pituitary surgery through endoscopic perspective. Ten sides of five adult cadaveric heads with red-colored latex injected arteries were evaluated. Endoscopic dissections were performed and measurements were done in the sphenoid sinuses before and after the removal of bony structures in all the aspects. Endoscopic vision of the sellar region enabled a wide panoramic perspective and detailed inspection. The measurements, in general, indicated the variations in the bony structures and soft tissues. The width of the pituitary, which is the distance between the medial margins of the carotid prominences, was measured as 21 +/- 2.5 mm and the distance between the medial margin of the carotid prominences at the lower margin of the pituitary was 18 +/- 3.1 mm. After the bony structures were removed, further measurements were done. The width of the pituitary, which is the distance between the medial margins of the anterior curvature of the ICA, was measured as 23.2 +/- 3 mm, while the distance between the posterior curvature of the ICA was 19.7 +/- 4.9 mm. Endoscopic view provided superior detailed visualization of the close relationships between pituitary gland, internal carotid arteries, and optic nerves. This facilitated exact evaluation for variations, which could result in more effective and safe surgery. However, these variations again emphasize the necessity of preoperative radiological evaluation in each case.
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Affiliation(s)
- A Unlu
- Department of Neurosurgery, Faculty of Medicine, Ankara University, Ankara, Turkey.
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Kurtaiş Y, Küçükdeveci A, Elhan A, Yılmaz A, Kalli T, Sonel Tur B, Tennant A. Psychometric properties of the Rivermead Motor Assessment: Its utility in stroke. J Rehabil Med 2009; 41:1055-61. [DOI: 10.2340/16501977-0463] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sadeghi F, Yurur-Kutlay N, Berberoglu M, Cetinkaya E, Aycan Z, Kara C, Ilgin Ruhi H, Ocal G, Siklar Z, Elhan A, Tukun A. Identification of frequency and distribution of the nine most frequent mutations among patients with 21-hydroxylase deficiency in Turkey. J Pediatr Endocrinol Metab 2008; 21:781-7. [PMID: 18825878 DOI: 10.1515/jpem.2008.21.8.781] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
UNLABELLED Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders mainly due to defects in the steroid 21-hydroxylase (CYP21A2) gene. METHODS To determine the mutational spectrum in the Turkish population, the CYP21A2 active gene was analyzed in 100 unrelated patients with the classical form of 21-hydroxylase deficiency using PCR and RFLP. RESULTS Mutations were detected in 78 patients: 64 patients were homozygous for one mutation, seven patients were compound heterozygous with different mutations on each chromosome, two patients were homozygous for two different mutations, five patients were heterozygous, and 22 patients harbored none of the tested mutations. The most frequent mutation was IVS2-13A/C (28.5%), followed by large gene deletion (17%), Q318X (11.5%), I172N (4%), V281L (3.5%), R356W (3.5%), 8-bp (3%), complex alleles (2%), P30L (1%) and E6 cluster (1%). CONCLUSION The distribution of mutation frequencies in our study was slightly different from those previously reported in Turkey and in other parts of the world.
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Affiliation(s)
- F Sadeghi
- Medical Genetics Department, Ankara University Faculty of Medicine, Ankara, Turkey.
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Kahilogullari G, Comert A, Arslan M, Esmer AF, Tuccar E, Elhan A, Tubbs RS, Ugur HC. Callosal branches of the anterior cerebral artery: an anatomical report. Clin Anat 2008; 21:383-8. [PMID: 18521950 DOI: 10.1002/ca.20647] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although the morphology of the corpus callosum is well defined, the arterial supply of this structure has not been comprehensively studied. To elucidate this further, 40 cerebral hemispheres from 30 adult cadaveric brains were obtained. The anterior cerebral arteries were cannulated and injected with red latex. The following were observed and documented: (1) the number, diameter, and course of the arteries supplying the corpus callosum; (2) the territories vascularized by these arteries; (3) any variations of the callosal arteries. Short callosal arteries were present in 58 hemispheres (96.6%) and supplied the superficial surface of the corpus callosum along its midline and were a primary arterial source to this structure. Long callosal arteries were found in 28 hemispheres (46.6%) and contributed to the pial plexus. The cingulocallosal arteries were present in all hemispheres and supplied the corpus callosum, cingulate gyrus, and also contributed to the pericallosal pial plexus. The recurrent cingulocallosal arteries were present in 17 hemispheres (28.3%) and also contributed to the pericallosal pial plexus. The median callosal artery, an anatomical variation, was present in 10 brains (33.3%). This vessel supplied the corpus callosum and the cingulate gyrus. The aim of the present study was to provide a detailed description of the arteries supplying the corpus callosum for those who encounter these vessels radiologically or surgically.
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Affiliation(s)
- G Kahilogullari
- Department of Neurosurgery, Ankara University, Faculty of Medicine, Ankara, Turkey
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Abstract
The infragluteal fold is one of the major concerns in reshaping of the gluteal region. This study reevaluated the fold both histologically and anatomically. Five fixed cadavers were used. The infragluteal fold on the right side was explored by dissection, whereas the infragluteal fold of the contralateral side was removed en bloc. Tissue samples (6 cm long x 2 mm thick) were taken at three points from each fold bloc: the most medial point, the middle point, and the most lateral end of the sulcus. Anatomic dissections and histologic examinations showed that the infragluteal fold consists of strong fibrous bands extending from the dermis of the medial one-third of the fold to the ramus of the ischium and sacrum, forming the letter J. The infragluteal fold, which attaches to both the ischium and the sacrum in a continuous fashion, is an anatomic structure in its medial part and only a crease laterally.
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Affiliation(s)
- O Babuccu
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Zonguldak Karaelmas University, Faculty of Medicine, 67200 Kozlu, Zonguldak, Turkey.
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Akkaya T, Comert A, Kendir S, Acar HI, Gumus H, Tekdemir I, Elhan A. Detailed anatomy of accessory obturator nerve blockade. Minerva Anestesiol 2008; 74:119-122. [PMID: 18354367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND The accessory obturator nerve (AON) often innervates the hip joint and adductor longus. The AON is present in 10-30% of patients, and thus it is clinically important that it is also considered during obturator nerve (ON) blockade. METHODS The study was performed on 12 cadavers (24 body-sides) and the AON beginning from the lumbar plexus was observed. The needle was classically penetrated into the ON to gain access to the AON and upon definition of detailed AON anatomy, morphometric measurements were conducted. In addition, novel maneuvers used in the study were described. RESULTS Throughout the dissections, the AON was detected on three sides (12.5%) and the mean AON- pubic tubercle distance was measured as 4.0 cm. The needle was withdrawn and positioned medially and almost parallel to the skin. It was then advanced through the superior pubic ramus to reach the AON. CONCLUSION Owing to its anatomical structure, the AON can be easily accessed during classical ON blockade using the maneuvers described here. Further clinical studies are needed to investigate if supplementing ON blockade with AON blockade might improve the clinical efficiency and quality of the blockade.
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Affiliation(s)
- T Akkaya
- Department of Anaesthesia and Pain Unit, Ankara Diskapi Training and Research Hospital, Ankara, Turkey.
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Akkaya T, Comert A, Kendir S, Acar H, Gumus H, Tekdemir I, Elhan A. 361 DOES THE PRESENCE OF ACCESORY OBTURATOR NERVE EFFECT THE SUCCESS OF OBTURATOR NERVE BLOCKADE? Eur J Pain 2006. [DOI: 10.1016/s1090-3801(06)60364-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Baykara M, Demirkazik A, Elhan A, Yalcin B, Buyukcelik A, Dogan M, Utkan G, Tek I, Doruk H, Akan H, Icli F. Lymphopenia and monocytopenia versus MASCC score system in patients with febrile neutropenia. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.18622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
18622 Background: The purpose of this study was determine the clinical significance of lymphopenia and monocytopenia in terms of its duration and depth in patients with febrile neutropenia (FEN) and MASCC scores parametres. Methods: Sixty-six patients with FEN were prospectively analysed. Recurrent FEN episodes were excluded in this trial. Twenty-four patients had solid tumors, 42 patients had lymphoma-leukemia. Patients with MASCC-scores ≥21 evaluated as low-risk (LR) and the ones with their scores <21 were high-risk (HR). Results: Thirty-six patients had HR and the rest had LR. Lymphocyte count <700/mm3 and monocyte count <100/mm3 were found as 91.6% and 86.6% in HR and in LR groups, respectively.The rate of refractory fever(RF) in HR patients was clearly high.Patients with protracted neutropenia (PN) had higher rate of RF (p = 0.007). Patients with longer duration of neutropenia and monocytopenia tended to have RF (p = 0.052, p = 0.018). The rate of administered AFT was significantly high in HR patients (p = 0.005). AFT was administered to one third of HR patients, but no patient received AFT in LR-group (p < 0.001). In group with neutropenia duration (ND) <10 days, one patient received AFP (p < 0.001). AFT was given to most of the patients who had longer duration of lymphopenia or monocytopenia (respectively; p = 0.002, p = 0.001), and who had leukemia (p = 0.001). The most important parameters effecting the duration of antibiotic therapy (DAT) was found to be ND. DAT >14 days was found more than fourfold in patients PN (p = 0.007). Fifty-five percent out of patients with solid tumor or lymphoma were given <14 days antibiotic therapy. But, most of patients with leukemia had antibiotics >14 days (p = 0.002).The rate of antibiotic therapy >14 days was higher in patients with longer duration of lymphopenia and monocytopenia (respectively; p = 0.073, p = 0.062). The most important parameter that influences on antibiotic modification (AM) was severity of monocytopenia on the first day of FEN. The rate of AM was found in aproximately nine-fold in patients that had monocyte counts ≤100/ mm3 as compared to monocyte ≥100/ mm3 (p = 0.01). Conclusions: The depth of monocytopenia and durations of lymphopenia and monocytopenia were the important parameter influencing antibiotic modification in FEN. No significant financial relationships to disclose.
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Affiliation(s)
| | | | - A. Elhan
- Ankara University, Ankara, Turkey
| | | | | | - M. Dogan
- Ankara University, Ankara, Turkey
| | - G. Utkan
- Ankara University, Ankara, Turkey
| | - I. Tek
- Ankara University, Ankara, Turkey
| | - H. Doruk
- Ankara University, Ankara, Turkey
| | - H. Akan
- Ankara University, Ankara, Turkey
| | - F. Icli
- Ankara University, Ankara, Turkey
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Duparc F, Noyon M, Ozeel J, Gerometta A, Michot C, Tadjalli M, Moslemy H, Safaei S, Heiman A, Wish-Baratz S, Melnikov T, Smoliar E, Hakan AY, Yucel F, Kachlík DK, Pešl MP, Báča VB, Stingl JS, Kachlík KD, Čech ČP, Báča BV, Mompeó B, Marrero-Rodriguez A, Zeybek A, Sağlam B, Çikler E, Çetinel Ş, Ercan F, Şener G, Kawawa Y, Kohda E, Tatsuya T, Moroi M, Kunimasa T, Nagamoto M, Terada H, Labuschagne BCJ, van der Krieke TJ, Hoogland PV, Muller CJF, Lyners R, Vorster W, Matusz P, Zaboi DE, Xu SC, Tu LL, Wang Q, Zhang M, Han H, Tao W, Jiao Y, Pang G, Aydin ME, Kopuz C, Demir MT, Yildirim M, Kale A, Ince Y, Khamanarong K, Jeeravipoolvarn P, Chaijaroonkhanarak W, Gawgleun W, Fujino T, Uz A, Apaydin N, Bozkurt M, Elhan A, Sheibani MT, Adibmoradi M, Jahovic N, Alican I, Erkanli G, Arbak S, Karakaş S, Taşer F, Güneş H, Yildiz Y, Yazici Y, Aland RC, Kippers V, Song WC, Park SH, Shin C, Koh KS, Russo G, Pomara F, Veca M, Cacciola F, Martorana U, Gravante G, Tobenas-Dujardin AC, Laquerrière A, Muller JM, Fréger P, López-Serna N, Álvarez-González E, Torres-Gonzàlez V, Laredo-López G, Esparza-González GV, Álvarez-Cantú R, Garza-González CE, Guzmán-López S, Aldur MM, Çelik HH, Sürücü S, Denk C, Yang HJ, Gil YC, Kim TJ, Lee HY, Lee WJ, Lee H, Hu KS, Akita K, Kim HJ, Jung HS, Gurbuz H, Balik S, Wavreille G, Chantelot C, Demondion X, Fontaine C, Çavdar S, Yalin A, Saka E, Özdoǧmuş Ö, Çakmak Ö, Elevli L, Saǧlam B, Coquerel-Beghin D, Milliez PY, Lemierre G, Oktem G, Vatansever S, Ayla S, Uysal A, Aktas S, Karabulut B, Bilir A, Uslu S, Aktug H, Yurtseven ME, Celik HH, Tatar I, Surucu S, Karaduman A, Tunali S, Neuhüttler S, Kröll A, Moriggl B, Brenner E, Loukas M, Arora S, Louis RG, Fogg QA, Wagner T, Tedman RA, Ching HY, Eze N, Bottrill ID, Blyth P, Faull RLM, Vuletic J, Elizondo-Omaña RE, Rodríguez MAG, López SG, de la Garza OT, Liu YH, Zhang KL, Lu DH, Kwak HH, Park HD, Youn KH, Kang HJ, Kang HC, Han SH, Ikiz ZAA, Ucerler H, Uygur M, Kutoglu T, Dina C, Iliescu D, Şapte E, Bordei P, Lekšan I, Marcikić M, Radić R, Nikolić V, Kurbel S, Selthofer R, Báča V, Doubková A, Kachlík D, Stingl J, Džupa V, Grill R, Nam YS, Paik DJ, Shin CS, Kim SJ, Kim DG, Jin CS, Kim DI, Lee UY, Kwak DS, Lee JH, Han CH, Carpino A, Rago V, Romeo F, Carani C, Andò S, Arican RY, Coskun N, Sarikcioglu L, Sindel M, Arican YR, Altun U, Ozsoy U, Oguz N, Yildirim FB, Nakajima K, Duygulu E, Aydin H, Gurer EI, Ozkan O, Tuzuner S, Özsoy U, Çubukçu S, Demirel BM, Akkin SM, Marur T, Weiglein AH, Maghiar TT, Borza C, Bumbu A, Bumbu G, Polle G, Auquit-Auckbur I, Dujardin F, Biga N, Olivier E, Defives T, Ghazali S, Anastasi G, Rizzo G, Favaloro A, Miliardi D, Giacobbe O, Santoro G, Trimarchi F, Cutroneo G, Govsa F, Bilge O, Ozer MA, Erdogmus S, Grizzi F, Pelillo F, Mori M, Franceschini B, Portinaro N, Godlewski G, Viala M, Rouanet JP, Prat D, Rahmé ZS, Prudhomme M, Eken E, Kwiatkowska M, Liegmann J, Chmielewski R, Grimmond J, Kwiatkowski M, Schintler MV, Windisch G, Wittgruber G, Prandl EC, Prodinger P, Anderhuber F, Scharnagl E, Gerbino A, Buscemi M, Leone A, Mandracchia R, Peri G, Lipari D, Farina-Lipari E, Valentino B, D’Arpa S, Cordova A, Bucchieri F, Ribbene A, David S, Palma A, Davies DE, Haitchi HM, Holgate ST, La Rocca G, Anzalone R, Campanella C, Rappa F, Bartolotta T, Cappello F, Bellafiore M, Sivverini G, Palumbo D, Macaluso F, Farina F, Di Felice V, Montalbano A, Ardizzone N, Marcianò V, Zummo G, Tanyeli E, Üzel M, Carini F, Scardina GA, Varia P, Valenza V, Messina P, Meiring JH, Schumann C, Whitmore I, Greyling LM, Hamel O, Hamel A, Robert R, Garçon M, Lagier S, Blin Y, Armstrong O, Rogez JM, Le Borgne J, Ifrim CF, Maghiar A, Botea M, Ifrim M, Pop O, Sandor M, Behdadipour Z, Saberi M, Esfandiary E, Gentile C, Marconi A, Livrea MA, Uzan G, D’Alessio P, Ridola CG, Grassi N, Pantuso G, Bottino A, Cacace E, Li Petri S, Di Gaudio F, Guercio G, Latteri MA, Nobile D, Cipolla C, Caruso G, Salvaggio G, Lo Cascio A, Fatta G, Lagalla R, Campisi A, Verderame F, Martegani A, Cardinale AE, Luedinghausen MV. Poster presentation. Surg Radiol Anat 2005. [DOI: 10.1007/bf03371476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Feigl G, Rosmarin W, Weninger B, Likar R, Hoogland PV, Groen RJM, Vorster W, Grobbelaar M, Muller CJF, du Toit DF, Moriggl B, Greher M, Klauser A, Eichenberger U, Prades JM, Timoshenko A, Faye M, Martin CH, Baroncini M, Baiz H, Ben Henda A, Fontaine C, Baksa G, Toth M, Patonay L, Gonçalves-Ferreira A, Gonçalves C, Neto L, Fonseca T, Gaspar H, Rino J, Fernandes M, Fernandes P, Cardoso H, Miranda B, Rego J, Hamel A, Guillouche P, Hamel O, Garçon M, Lager S, Blin Y, Armstrong O, Robert R, Rogez JM, Le Borgne J, Kahilogulları G, Comert A, Esmer AF, Tuccar E, Tekdemir I, Ozdemir M, Odabasi AB, Elhan A, Anand MK, Singh PR, Verma M, Raibagkar CJ, Kim HJ, Kwak HH, Hu KS, Francke JP, Macchi V, Porzionato A, Parenti A, Metalli P, Zanon GF, De Caro R, Bernardes A, Dionísio J, Messias P, Patrício J, Apaydin N, Uz A, Evirgen O, Shim KS, Park HD, Youn KH, Cajozzo M, Bartolotta T, Cappello F, Sunseri A, Romeo M, Altieri G, Modica G, La Barbera G, La Marca G, Valentino F, Valentino B, Martino A, Dees G, Kleintjes WA, Williams R, Herpe B, Leborgne J, Lagier S, Cordova A, Pirrello R, Moschella F, Mahajan MV, Bhat UB, Abhayankar SV, Ambiye MV, Kachlík DK, Stingl JS, Sosna BS, Fára PF, Lametschwandtner AL, Minnich BM, Straka ZS, Ifrim M, Ifrim CF, Botea M, Latorre R, Sun F, Henry R, Crisóstomo V, Cano FG, Usón J, Mtez-Gomaríz F, Climent S, Hurmusiadis V, Barrick S, Barrow J, Clifford N, Morgan F, Wilson R, Wiseman L, Fogg OA, Loukas M, Tedman RA, Capaccioli N, Capaccioli L, Mannini A, Guazzi G, Mangoni M, Paternostro F, Vagnoli PT, Gulisano M, Pacini S, Grignon B, Jankowski R, Hennion D, Zhu X, Roland J, Mutiu G, Tessitore V, Uzzo ML, Bonaventura G, Milio G, Spatola GF, Ilkan T, Selcuk T, Mustafa AM, Hamdi CH, Emel TC, Faruk U, Hamdi CH, Bulent G, Báča V, Doubková A, Kachlík D, Stingl J, Saylam C, Kitiş Ö, Üçerler H, Manisahı E, Gönül AS, Dashti GHR, Nematbaksh M, Mardani M, Hami J, Rezaian M, Radmehr B, Akbari M, Paryani MR, Gilanpour H, Zamfir C, Zamfir M, Lupusoru C, Raileanu C, Lupusoru R, Bordei P, Iliescu D, Şapte E, Adam S, Baker C, Sergi C, Barberini F, Ripani M, Di Nitto V, Zani A, Magnosi F, Heyn R, Familiari G, Elgin U, Demiryurek D, Berker N, Ilhan B, Simsek T, Batman A, Bayramoglu A, Fogg QA, Bartczak A, Kamionek M, Kiedrowski M, Fudalej M, Wagner T, Artibani W, Tiengo C, Taglialavoro G, Mazzoleni F, Scapinelli R, Ardizzone E, Cannella V, Peri D, Pirrone R, Peri G. Platform session. Surg Radiol Anat 2005. [DOI: 10.1007/bf03371475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Petri E, Niemeyer R, Petri E, Niemeyer R, Sivaslioglu AA, Haberal A, Dölen I, Dede H, Akkök E, Deveci S, Demir B, Aksakal O, Ugur M, Yilmaz B, Yesilyurt H, Mollamahmutoglu L, Sivaslioglu AA, Elhan A, Sakul U, Dölen I, Tunc E, Ercan F, Haberal A, Aksakal O, Tuncay G, Aytan H, Tapisiz OL, Bilge U, Mollamahmutoglu L, Aksakal O, Tuncay G, Bal S, Bilge U, Tapisiz OL, Mollamahmutoglu L, Unlu S, Aksakal O, Tapisiz OL, Tuncay G, Aytan H, Ugur M, Bilge U, Mollamahmutoglu L, Yasar L, Yazicioglu F, Efe C, Sönmez S, Zebitay AG, Süt N, Sensoy Y, Cebi Z, Bayrak O, Cimentepe E, Gümüs II, Dede H, Sivaslioglu A, Dolen I, Dede FS, Seckin L, Haberal A, Sivaslioglu AA, Dolen I, Dede H, Dilbaz S, Demir B, Sümer C, Gelisen O, Unlubilgin E, Deveci S, Dede S, Seckin L, Haberal A, Dönmez MD, Atis A, Aydin Y, Tandogan T, Ozpak D, Oruc O, Aksakal OS, Doganay M, Aytan H, Gungor T, Bal S, Bilge U, Mollamahmutoglu L, Ozdegirmenci O, Dede FS, Haberal A, Karslioglu Y, Karadeniz S, Gunhan O. Urogynecology. Arch Gynecol Obstet 2005. [DOI: 10.1007/bf02954774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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16
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Karatas A, Caglar S, Savas A, Elhan A, Erdogan A. Microsurgical anatomy of the dorsal cervical rootlets and dorsal root entry zones. Acta Neurochir (Wien) 2005; 147:195-9; discussion 199. [PMID: 15565478 DOI: 10.1007/s00701-004-0425-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Detailed anatomical knowledge of the dorsal cervical rootlets and dorsal root entry zones (DREZ) is important for the diagnosis and treatment of cervical myeloradiculopathy and surgical management of pain. There are far fewer micro-anatomical studies of this area than gross anatomical studies. This study presents several anatomical points regarding the dorsal cervical rootlets and dorsal root entry zones. METHOD Fifteen adult formalin-fixed cadaveric spines from C1 to T1 were used to observe the posterior structures. They were studied under the surgical microscope following en bloc laminectomy and foraminotomy. The morphological features of the dorsal root entry zones and dorsal rootlets were determined. The distance from the midline to the DREZ, the longitudinal length of the DREZ in the spinal canal, the length of the dorsal rootlets, the number of dorsal rootlets and the intersegmental anastomoses between the dorsal rootlets were measured. FINDINGS The distance from the midline to the DREZ ranged from 1.1 to 4.7 mm. Longitudinal length of the dorsal rootlets ranged 4.3-17.7 mm. The shortest length of the dorsal rootlets ranged between 5-28 mm, and longest lengths of the dorsal rootlets ranged 6.8-30.3 mm. The number of dorsal rootlets ranged from 2-13. Between the C2-T1 dorsal rootlets, 142 connections out of 30 intersegments were noted. CONCLUSIONS The distance from the midline to the DREZ decreased in the lower cervical spine. The longest longitudinal length of the DREZ was at the C5 level. The length of the dorsal rootlets was increased in the lower cervical spine. The average number of dorsal rootlets tended to increase in the lower cervical spine. Anastomoses were most often found between C6-7 and C5-6 dorsal rootlets. Knowledge of the anatomical features of dorsal cervical rootlets and dorsal root entry zones is essential for a surgeon to avoid injuring the neural structures. This knowledge is a must not only to avoid complications but also for the success, safety and effectiveness of microsurgical operations of the pathological conditions like posterior myeloradiculopathy and pain treatment such as DREZ operations.
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Affiliation(s)
- A Karatas
- Department of Neurosurgery, Fatih University School of Medicine, Ankara, Turkey.
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17
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Abstract
Both the course and localization of the transverse facial artery are described, based upon the bilateral dissection of heads from 20 human cadavers. Its anatomical relationships with the mandibular fossa, the articular tubercle, the zygomatic arch, the parotid duct and the maxillary artery are studied and morphometric features are calculated. Furthermore, the transverse facial territory was examined. This territory was supplied by a single perforating branch in 28 cases, by two perforating branches in 10 and by three perforating branches in 2. Knowledge of the course and relationships of the transverse facial artery should help to protect this artery from the risk for transection. However, the variable course of the transverse facial artery must always be taken into consideration by the clinicians during surgical procedures.
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Affiliation(s)
- R Başar
- Department of Anatomy, Hacettepe University, Faculty of Medicine, 06100 Ankara, Turkey
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18
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Cankal F, Apaydin N, Acar HI, Elhan A, Tekdemir I, Yurdakul M, Kaya M, Esmer AF. Evaluation of the anterior and posterior ethmoidal canal by computed tomography. Clin Radiol 2004; 59:1034-40. [PMID: 15488853 DOI: 10.1016/j.crad.2004.04.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2003] [Revised: 03/30/2004] [Accepted: 04/16/2004] [Indexed: 11/29/2022]
Abstract
AIM To examine the anatomy, length and angulation of the anterior and posterior ethmoidal canals (AECs and PECs) using computed tomography (CT), and to determine the anatomical landmarks in which the canals are expected to be seen in transverse and coronal planes. MATERIALS AND METHODS CT images of 150 patients were analysed. One, 2, and 3 mm thick sections were obtained separately in axial and coronal images. The frequency of visualization of the AECs and PECs, and if present, a third canal, was noted. The course and the angulation of the AEC and the PEC in transverse and coronal planes were recorded. On axial sections the distance between the AEC and PEC and the previously defined landmarks were measured. On coronal images, the distances were calculated from the thickness of the cross-section and the number of sections between the various structures. RESULTS The AEC was identified as a separate canal in 84% of patients, and was embedded in the ethmoid roof in 16%. The PEC was seen as a separate canal in 8% and was present in the ethmoid roof in 92%. On the 1 mm thick coronal and transverse sections, a third canal was identified at the junction of the middle and posterior third of the AEC-PEC distance in both of the images. The average lengths of these canals were 4-12 mm (mean 8.2 mm) for the AEC, and 2-13 mm (mean 7.6 mm) for the PEC. CONCLUSIONS To avoid the complications that can develop during endoscopic sinus surgery; the course, length and the angulations of the anterior and posterior ethmoidal arteries and their canals can be identified by CT in standard positions if a sufficiently thin section thickness is used. The present study has shown the exact CT localization of the AECs and PECS, which are frequently overlooked when evaluating para-nasal sinuses.
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Affiliation(s)
- F Cankal
- Department of Radiology, T. Yuksek Ihtisas Hospital, Ankara, Turkey
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19
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Top�u �, Karakayali F, Kuzu M, �zdemir S, Erverdi N, Elhan A, Aras N. The authors reply. Surg Endosc 2004. [DOI: 10.1007/s00464-003-9262-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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20
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Abstract
The fossa navicularis is a relatively rare anatomic variation of the skull base. Awareness of its existence will avoid misinterpretations of radiological images and unnecessary investigations. This study describes the appearance of the fossa navicularis, and investigates its incidence and whether it is related to pathology at the basiocciput. We studied 492 dry human skulls and 525 computer tomography (CT) images of patients. Dry skulls showing a fossa navicularis were investigated by CT scan, whereas patients identified as having a fossa navicularis were further examined with magnetic resonance imaging (MRI). To document the position of the fossa more precisely, measurements were made between the fossa navicularis and certain anatomic landmarks such as the foramen ovale, the pharyngeal tubercle, the posterior border of the vomer, the foramen lacerum, the carotid canal, and the occipital condyle. Upon examination, 26 of 492 skulls (5.3%) were found to have a fossa navicularis. Twelve were <2 mm in depth and the other 14 had a depth of >/=2 mm. Of the 525 patients, 16 (3.0%) were identified as having a fossa navicularis in CT images. Evaluation of MRIs showed no soft tissue lesions in any of these patients. Comprehensive anatomic details of the fossa navicularis have not been reported in the literature. The results of this study may be useful to radiologists, anatomists, and surgeons interested in the skull base.
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Affiliation(s)
- F Cankal
- Department of Anatomy, Ankara University Medical School, Ankara, Turkey
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21
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Ozer H, Tekdemir I, Elhan A, Turanli S, Engebretsen L. A clinical case and anatomical study of the innervation supply of the vastus medialis muscle. Knee Surg Sports Traumatol Arthrosc 2004; 12:119-22. [PMID: 12756522 DOI: 10.1007/s00167-003-0382-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2002] [Accepted: 03/06/2003] [Indexed: 11/28/2022]
Abstract
The innervation supply to the vastus medialis (VM) muscle, a component of quadriceps femoris (QF), is provided by a branch of the femoral nerve (FN) running along the muscle. The course of the nerve from lumbar roots to the muscle has been described by many researchers. It is known to ride along the femoral vein, artery and saphenous nerve and enter the adductor canal (Hunter's canal), and then to divide into branches that supply vastus medialis and the knee joint. Femoral mononeuropathy is uncommon, and is usually due to compression in the spinal level. Hematoma in the psoas and iliacus muscles, drug abuse, lithotomy position and limb lengthening are the other associated reasons for a mononeuropathy of the femoral nerve. Isolated vastus lateralis (VL) atrophies have been reported by a few authors, suggesting that compression of the nerve and direct violation of the nerve with injections might be the reason for mononeuropathy. Isolated VM atrophy has not been previously reported. The purpose of the study was to identify the anatomical structures around the FN branch which innervates the VM muscle.
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Affiliation(s)
- H Ozer
- 2nd Department of Orthopaedics and Traumatology, Dr. Muhittin Ulker Emergency Care and Traumatology Hospital, Ankara, Turkey.
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Bengisun U, Tagil SM, Elhan A. Accessibility of calf perforating veins from the superficial posterior compartment: an anatomic dissection study. Eur J Vasc Endovasc Surg 2003; 25:552-5. [PMID: 12787698 DOI: 10.1053/ejvs.2002.1878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES to determine the anatomic location of medial perforating veins (PVs) and their course within the compartments of the leg. MATERIALS AND METHODS the lower extremity veins of 15 cadavers were filled with coloured latex solution. Medial PVs between the ankle and the knee were dissected out. RESULTS in total 95 direct PVs (mean 6.3 per extremity, range 3-9) were identified and classifed as Cockett I, II, or III, proximal and distal paratibial and Boyd. Cockett PVs were present in more than half of the cases, of which the majority (except Cockett I) were located in the superficial posterior compartment. Whereas the vast majority of Cockett PVs originate from the posterior arch vein, the other perforators originate from the greater saphenous vein. CONCLUSIONS only 62% of all PVs pass through the superficial posterior compartment. As a result, during subfascial endoscopic perforating vein surgery (SEPS), at least one third of patients require a paratibial fasciotomy in order to reach and ligate the PVs.
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Affiliation(s)
- U Bengisun
- Department of General Surgery, Ankara University, Ankara, Turkey
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Topçu O, Karakayali F, Kuzu MA, Ozdemir S, Erverdi N, Elhan A, Aras N. Comparison of long-term quality of life after laparoscopic and open cholecystectomy. Surg Endosc 2003; 17:291-5. [PMID: 12364987 DOI: 10.1007/s00464-001-9231-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2001] [Accepted: 05/06/2002] [Indexed: 10/27/2022]
Abstract
BACKGROUND Although many studies have compared open and laparoscopic procedures, showing many advantages in favor of the laparoscopic technique during the early postoperative period, only a limited number of reports in the literature compare the two techniques during the later follow-up period with regard to quality of life. This study aimed to compare the effects of these two cholecystectomy techniques on the quality of life and clinical outcome of the patients during long-term follow-up evaluation. METHODS This study evaluated 200 patients who underwent cholecystectomy operations with either technique between 1993 and 1999 in our department. There were 100 patients in each group. Both groups were similar with respect to age, gender, body mass indexes, American Society of Anesthesiology (ASA) scores, and indications for surgery. The Medical Outcome Study Short Form 36 Health survey (SF-36), which includes 36 items, was used for evaluating the quality-of-life index. In addition to this, a system-specific instrument for gastrointestinal diseases was used to investigate clinical outcome. RESULTS The mean administration time for the questionnaire was 46.8 +/- 18.7 months in the laparoscopic cholecystectomy (LC) group and 41.5 +/- 16 months in the open cholecystectomy (OC) group. Statistically significant differences were noted in the scores for all eight SF = 36 health status domains in favor of laparospopic surgery. No statistically significant difference was found for abdominal pain, location of the pain, referral to a doctor for the pain, accompanying symptoms, relieving factors for the pain, distention, and dyspeptic complaints, usage of antacid therapy, weight changes, changes in bowel habit, need for a special diet, or sexual functions between the two groups. CONCLUSIONS The gastrointestinal clinical symptoms were similar in the two groups during the long-term follow-up evaluation, but laparoscopic cholecystectomy was found to be significantly superior to the open technique with respect to the quality of life over the long term.
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Affiliation(s)
- O Topçu
- Department of Surgery, University of Ankara, Ankara, Turkey
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Abstract
The anatomy of the internal anal sphincter and surrounding structures was investigated in 24 cadavers using a surgical microscope (6-25 x magnification). An understanding of the anatomy of the internal anal sphincter is helpful in avoiding complications during surgical procedures in the anorectal region. The external anal sphincter was composed of three ellipsoid rings of skeletal muscle (subcutaneous, superficial, and deep) that encircle the anal canal; in contrast, we found that the internal anal sphincter was composed of flat rings of smooth muscle bundles stacked one on top of the other, like the slats of a Venetian blind. In each anal canal, the average number of ring-like slats observed was 26.33 +/- 2.93 (range = 20-30) and each was covered by its own fascia. The smooth muscle fibers and fascia coalesced at three equidistant points around the anal canal to form three columns that extended distally into the lumen and differed in form from the other anal columns. When viewed from an anterior position, the columns were located anteriorly at the observer's right (5 o'clock position), posteriorly at the right (1 o'clock position), and laterally at the left (9 o'clock position). This heretofore unreported anatomy of the internal anal sphincter may play an important role in closing off the lumen of the anal canal and maintaining bowel continence.
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Affiliation(s)
- A Uz
- Ankara University, Faculty of Medicine, Department of Anatomy, Ankara, Turkey.
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Abstract
This cadaver study investigated the innervation patterns of the abductor digiti minimi in Guyon's canal. There was only one branch to the abductor digiti minimi in 22 of the 30 specimens. Two branches were found in three hands, and three branches in two. Three other variations were documented.
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Affiliation(s)
- E Gudemez
- Department of Surgery and Traumatology, Kirkkdale University Faculty of Medicine, Turkey.
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Apan A, Baydar S, Yilmaz S, Uz A, Tekdemir I, Güney S, Elhan A, Baydar P, Yýlmaz S, Tekdemir Y, Güney P. Surface landmarks of brachial plexus: ultrasound and magnetic resonance imaging for supraclavicular approach with anatomical correlation. Eur J Ultrasound 2001; 13:191-6. [PMID: 11516629 DOI: 10.1016/s0929-8266(01)00131-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The present study is able to describe a certain line, under which brachial plexus (BP) lies underneath in the supraclavicular region. A line drawn between midpoint of the sternocleidomastoid muscle to the midpoint of the clavicle was considered for BP. Surface landmarks were evaluated by applying ultrasound (US) on 30 volunteers (15 female, 15 male). Axial and sagittal views of BP were taken and distances between skin and BP were measured. Coronal magnetic resonance (MR) sections were taken from 7 volunteers according to the second line after applying two fat capsules on each line. The sonographic views were seen at the same line. Mean distances from skin were found as 16.5+/-0.7 mm for male and 14.5+/-0.5 mm for female volunteers. MR images were obtained bilaterally, which were parallel and posterior from sonographic lines. Surface landmarks, as presented in this study, are simple to accomplish and are not dependent on structural variations as external jugular vein.
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Affiliation(s)
- A Apan
- Department of Anesthesiology, Kirikkale University, Kýrýkkale, Turkey
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Abstract
The microsurgical anatomy of the jugular foramen was studied in 12 formalin preserved cadavers (24 foramina) and 40 dry-skulls (80 foramina). The jugular foramen was exposed by microsurgical dissection with drilling from a superior to inferior direction. Observations regarding dural architecture of the jugular foramen and relationships between neurovascular structures passing through the foramen were noted in cadavers. Normal bony construction of the foramen and its variational anatomy were examined in dry-skull specimens. Using photographs and drawings, the anatomy of the jugular foramen is presented and related terminology is discussed in the light of a literature review.
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Affiliation(s)
- I Tekdemir
- Anatomy Department, Ankara University School of Medicine, Ankara, Turkey.
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Kazkayasi M, Ergin A, Ersoy M, Bengi O, Tekdemir I, Elhan A. Certain Anatomical Relations and the Precise Morphometry of the Infraorbital Foramen???Canal and Groove: An Anatomical and Cephalometric Study. Laryngoscope 2001; 111:609-14. [PMID: 11359128 DOI: 10.1097/00005537-200104000-00010] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine and to standardize the certain anatomical relations, and the precise size, course, and location of the infraorbital foramen, canal, and groove for facilitating surgical and invasive procedures. STUDY DESIGN This anatomical study consisted of two main steps, namely, the examination of skulls and the cephalometric analysis of the skulls. Measurements of the skulls and of the radiograms were performed. METHODS Thirty-five adult bony heads (70 sides) were studied regarding the localization and dimensions of the infraorbital groove (IOG), infraorbital canal (IOC), and infraorbital foramen (IOF) as well as their relationships with different anatomical landmarks. The cephalometric analysis of the skulls was measured for evaluating the relationships of certain anatomical points and the distances of the skulls in the cephalometric analysis. For this purpose, 13 different distances and two angles were measured on anteroposterior and lateral craniographies. Differences between data of skull and cephalogram measurements were analyzed by the Student t test. The Pearson correlation test was used in the statistical analysis of the 15 values in the cephalogram. RESULTS Examination of the 70 sides of the 35 bony heads revealed that the shape of the IOF was oval in 34.3%, round in 38.6%, and semilunar in 27.1% of all skulls. The IOF was single in 94.3% and double in 5.7% of the cases. The average distance from the IOF to the infraorbital margin and to the lateral process of the canine tooth in vertical direction and to the lateral nasal border in horizontal direction were 7.19 +/- 1.39 mm, 33.94 +/- 3.15, and 17.23 +/- 2.64 mm, respectively. In cephalometric analysis, when S-N (the distance between the center of the sella turcica and the nasion) and N-ANS (the distance between the nasion and the anterior nasal spine) distances were used as independent parameters for the linear analysis, the correlation of the three values for both independent parameters were statistically significant. CONCLUSION While the IOF has no statistically significant changes with regard to the size of the skull, expressive changes take place in the course and the length of the IOG and IOC. Meticulous preoperative evaluation of the IOF and the route of the infraorbital nerve are necessary in patients who are candidates for maxillofacial surgery and regional block anesthesia. If these measurements are taken into account, there will be little surgical risk, and this will be helpful in identifying the extent of the operative field.
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Affiliation(s)
- M Kazkayasi
- Department of Otorhinolaryngology--Head and Neck Surgery, Kirikkale University School of Medicine, Ankara, Turkey
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Abstract
OBJECTIVE To describe the nature of functional recovery of 67 Turkish survivors of first-episode stroke who were referred for inpatient rehabilitation and to identify the variables that best predict discharge functional status of these patients. DESIGN A retrospective, descriptive study of the demographic and clinical profile and the functional status of patients with first-episode stroke. RESULTS The mean age was 60 (11.8, SD) yr, and 35.8% were men. The mean onset-admission interval and length of stay were 62.9 and 97.1 days, respectively. The mean functional status score, as measured by the FIM instrument, at the time of admission was 75 compared with 86.7 at the time of discharge, showing a mean improvement of 11.7. Although rehabilitation gains were similar for the right- and left-side involved groups, patients with right-side paresis had lower FIM scores at the time of admission than did the left-side involved group. Significant predictors of functional status at the time of discharge were admission functional status score and onset-admission interval. CONCLUSION Knowledge of these predictors can contribute to more appropriate treatment and discharge planning.
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Affiliation(s)
- G Yavuzer
- Department of Physical Medicine, Ankara University Medical School, Turkey
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Uğur HC, Uz A, Attar A, Tekdemir I, Egemen N, Elhan A. Anatomical projection of the cervical uncinate process in ventral, ventrolateral, and posterior decompressive surgery. J Neurosurg 2000; 93:248-51. [PMID: 11012055 DOI: 10.3171/spi.2000.93.2.0248] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The cervical uncinate processes (UPs), their variations, and the relationships between the neurovascular structures and surrounding bone were investigated in this anatomical study. The object of this study was to highlight the important surgery-related considerations associated with ventral, ventrolateral, and posterior decompressive surgery. METHODS Forty-nine adult C3-7 dry bone samples were used, and 10 measurements were obtained for each vertebra. The anterior measurements involved the cervical uncinate process (UP): height, width, length, distance between its tip and vertebral foramina, interuncinate process distance, sagittal angle with the superior margin of the vertebral body (VB), VB anteroposterior diameter, and VB width. Posterior measurements involved the vertical distance between the superior border of the lamina at the lamina-facet joint and the tip of the UP, as well as the horizontal distance between the medial-most border of the superior facet and the tip of the UP. All symmetrical structures were measured bilaterally. There were no statistically significant differences between right- and left-sided measurements in this series. The height of the UP increased gradually at each segmental level between C-3 and C-7. The width of the UP did not change with segmental level (5.0 mm at C-3 compared with 5.3 mm at C-7). On average, the length of the UP was relatively constant. The distance from the tip of the UP to vertebral foramina averaged 1 mm at the C2-3 level and 1.5 mm at the C5-6 level. Interuncinate distance and VB width gradually increased and were highly variable, which appeared to be related with osteophyte formation. There was a slight gradual increase from C-3 to lower segments, and it paralleled with the midline anteroposterior diameter of the same VB. The angle between the UP and the superior margin of the VB exhibited great variety. The posterior measurements decreased gradually from C-3 to C-7. CONCLUSIONS Based on the data obtained in this study, a surgeon is provided with a three-dimensional orientation as well as anatomical knowledge. This knowledge also allows for a more effective neurovascular decompression by minimizing the surgery-related complications.
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Affiliation(s)
- H C Uğur
- Department of Neurosurgery, Faculty of Medicine, The University of Ankara, Turkey
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Akbay A, Elhan A, Ozcan C, Demirtaş S. Hierarchical cluster analysis as an approach for systematic grouping of diet constituents on basis of fatty acid, energy and cholesterol content: application on consumable lamb products. Med Hypotheses 2000; 55:147-54. [PMID: 10904432 DOI: 10.1054/mehy.1999.1038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The role of dietary fat in the etiology of chronic diseases is both a qualitative and a quantitative issue. The dietary fat intake is largely influenced by behavioral and social influences on food choice. Ongoing scientific research has led to dietary recommendations with main concerns being the percentage of saturated, essential fatty acids and cholesterol with respect to total energy intake. However, the compositional complexity of food choice constituting the diet is a critical concept complicating the interpretation of epidemiologic, clinical and laboratory evidence to define the role of dietary fat in the etiology of diseases. This study was conducted on the observation of the need to better systematically classify consumable food based on complex composition and lamb meat is randomly selected as a non-specific subset for application of hierarchical cluster analysis method to obtain the dendogram using average linkage. Data on fat composition of consumable lamb prepared by different methods was obtained from USDA Nutrient Database for Standart Reference. Using agglomerative hierarchical cluster analysis lamb meat was grouped into two main clusters among which one divided into two families of which each was subdivided into two subfamilies based on fatty acids, cholesterol and energy composition. Present work may be considered as a leading study to systematically classify larger food sets. As high fat foods are rich in flavor and overall palatability, the outcome of this study may lead to behaviorally more acceptable but healthier dietary replacements. Besides future use of the results obtained may reveal the effect of complex compositional dietary influences on health and disease and may have superiority to studies questioning individual dietary items. Furthermore, hieararchial cluster analysis may be used to cluster food including other compositional data in food items like amino acids, vitamins, carbohydrates, as well.
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Affiliation(s)
- A Akbay
- Faculty of Medicine, Department of Biochemistry, Ankara University, Turkey.
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Abstract
There are no detailed descriptions of the neural structures that may be seen during surgical interventions of the pelvis. Anatomic dissections were performed to see which nerves are endangered in approaches to the anterior sacroiliac joint for plate fixations. Sixty cadavers were dissected bilaterally. Fifty-one were male and nine were female. L4 and L5 nerve roots were followed along the sacroiliac joint from the intervertebral foramen to the entrance into the lesser pelvis. Measurements were made between the nerves and sacroiliac joint from the proximal end of the joint to the pelvic brim. The L4 nerve root and the lumbosacral trunk (and not the L5 nerve root) were the nerves most susceptible to injury because of their course and proximity to the sacroiliac joint. As a result, during the anterior approach and fixation of the sacroiliac joint with plates, extreme care should be taken to identify the L4 nerve root or lumbosacral trunk or both at the anteroinferior third of the joint because the distance between the nerve and the joint is less than 1 cm.
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Affiliation(s)
- D Atlihan
- Ankara Training and Research Hospital, Turkey
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Abstract
Preoperative evaluation of the facial nerve (FN) anatomy within the temporal bone by high-resolution computed tomography (HRCT) helps in minimizing surgical trauma to the nerve. In order to demonstrate the radiological correlation of the intratemporal FN, eight adult, formalin-preserved cadavers were studied by comparing the transaxial and coronal sections of HRCT with anatomic microdissection findings. It was possible to visualize all segments of the FN canal in its intratemporal course. The most difficult part of the FN to demonstrate was the pyramidal section. Anatomic microdissection findings were consistent with the HRCT images. It was concluded that adequate information on the FN anatomy could be obtained from standard HRCT scans.
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Affiliation(s)
- E Tüccar
- Department of Anatomy, Ankara University, Faculty of Medicine, Ankara, Turkey
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Tuccar E, Uz A, Tekdemir I, Elhan A, Ersoy M, Deda H. Anatomical study of the lateral wall of the cavernous sinus, emphasizing dural construction and neural relations. Neurosurg Rev 2000; 23:45-8. [PMID: 10809487 DOI: 10.1007/s101430050031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study aims to determine the microscopic anatomy of the layers of the lateral wall of the cavernous sinus (CS) and, in particular, intends to examine the location and relations of the dural openings on the deep layer. Forty sides of 20 formalin-fixed and fresh cadavers were dissected and their CS examined. In 12 cases we found an opening on the deep dural layer; however, in four of them the inferolateral trunk of the internal carotid artery (ICA) was identified through these dural openings. We noticed the trochlear nerve making a curve (5% of cases) or lying close to the ophthalmic nerve (12.5%) on the lateral wall. In one case, the triangular area described by Parkinson could not be exposed surgically. Our findings indicate the importance of the heterogeneous courses of the cranial nerves lying on the lateral wall and point to the significance of the dural openings, which can influence the etiology of neoplastic invasions originating from the CS.
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Affiliation(s)
- E Tuccar
- University of Ankara, Faculty of Medicine, Department of Anatomy, Sihhiye, Turkey
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Ay S, Tekdemir I, Sayli U, Elhan A, Erbil KM, Başar R. Relation of the radial nerve with the sulcus nervi radialis: a morphometric study. Okajimas Folia Anat Jpn 1999; 76:197-202. [PMID: 10565203 DOI: 10.2535/ofaj1936.76.4_197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The radial nerve's course from the axillary region, branch patterns and the relation of the nerve to fixed anatomical landmarks in the arm region were studied in 27 embalmed intact cadavers. The radial nerve and its relation with the sulcus nervus radialis (SNR) was analyzed. The direct contact of the nerve with humerus in SNR was observed during the dissections. The following measurements were made: the total length of the humerus (the palpable uppermost point of the tuberculum majus and the lateral epicondyle); proximal safe zone (the tuberculum majus and the proximal beginning of the SNR); distal safe zone (the intercondylar axis and the middle of SNR); lateral safe zone (the lateral epicondyle and the distal end of SNR). In conclusion, it was aimed to correlate the osseus palpable landmarks of humerus with the course of the radial nerve for a safe surgery as the sulcus nervi radialis region is one of the main risky areas for the radial nerve palsies.
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Affiliation(s)
- S Ay
- Department of Anatomy, Faculty of Medicine, Ankara University, Turkey
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Abstract
OBJECTIVE Translabyrinthine approach (TLA) is a procedure of choice for the removal of vestibular schwannomas in cases of profound hearing loss. There is a lack of anatomic studies reviewing the surgical anatomy of the cerebellopontine angle (CPA) as seen in the classical and enlarged TLAs. METHODS Seven formalin-preserved cadavers were dissected. Structures, visualized in the CPA through the TLA, were scored according to the degree of their exposure (1, structure not seen; 2, partial exposure; 3, full exposure). RESULTS The acousticofacial bundle, anterior inferior cerebellar artery and flocculus had the highest scores in both types of surgery. However. the fifth, ninth, and tenth cranial nerves, prepontine cistern, pons, superior cerebellar artery, and posterior inferior cerebellar artery had higher scores, i.e. better exposure, in the enlarged TLA than in the classical TLA. CONCLUSION These findings suggest that the enlarged TLA be preferred in cases of larger tumors extending to either jugular foramen or middle fossa whereas the indications of the classical TLA should be limited to vestibular neurectomy and removal of smaller tumors.
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Affiliation(s)
- A Aslan
- First ENT Clinic of Numune State Hospital, Ankara, Turkey
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Abstract
The anatomy of the subarcuate canaliculus (SAC), subarcuate fossa (SAF) and subarcuate artery (SAA) was studied in 12 cadavers and 35 dry temporal bones. Each cadaver was scanned with high resolution CT (HRCT) prior to microdissection. The SAC was always found to be a single canal located between the two arcs of the anterior semicircular canal in both microdissections and HRCT scans and the internal acoustic meatus was observed to be located just inferior to the SAC. The SAC was on average of 9.2 mm in length and 1 mm in width. The SAF was situated at a distance of 4.2 mm from the internal acoustic meatus, 3.5 mm from the groove for the superior petrosal sinus, 6.7 mm from the opening of the vestibular canaliculus and 11.5 mm from the most superior part of the jugular foramen. The SAA was found to originate from the anterior inferior cerebellar artery in 9 cadavers and from the internal auditory artery in 3 cadavers. The SAA always emerged from the main artery outside the internal acoustic meatus. It ran through the SAC as a single artery. This study investigated CT correlated anatomical aspects of the subarcuate canaliculus and its artery which is claimed to be responsible for the blood supply of the mastoid antrum, facial canal and bony labyrinth.
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Affiliation(s)
- I Tekdemir
- Anatomy Department of Ankara University, School of Medicine, Sihhiye, Ankara, Turkey
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Abstract
BACKGROUND Advances in microsurgical techniques made possible the removal of advanced jugular foramen (JF) lesions, which once had been accepted as unoperable. However, successful surgery requires detailed knowledge of the JF anatomy. METHODS Sixteen jugular foramina in eight formalin-preserved adult cadavers were scanned with axial and coronal high resolution computed tomography (HRCT) prior to dissection. After craniectomy and removal of brain tissue, the relationships of the neurovascular structures in the JF were determined by drilling the temporal bones from superior to inferior on planes parallel to the skull base. RESULTS No bony partition of the JF was observed. A dural band consistently divided the JF into two parts. Anterior to it was the glossopharyngeal nerve (IX) while the vagus (X) and accessory (XI) nerves were located posteriorly. There was a notch in which the IX nerve entered the JF. It was also identified on the CT scans and defined as the glossopharyngeal recess. The IX nerve made a genu within the JF in all specimens. Then, it ran inferiorly through a bony canal in three specimens (18.75%), and through an incomplete bony canal in two (12.5%), which were also defined on the CT images. The inferior petrosal sinus ran through a sulcus anteromedial to the glossopharyngeal recess. The posterior meningeal artery was found to be located between the X and XI nerves within the JF. CONCLUSIONS This study revealed a complex and highly variable pattern of the relationships of the neurovascular structures in the JF, and their HRCT images correlated well with the anatomic microdissections.
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Affiliation(s)
- I Tekdemir
- Anatomy Department of Ankara University School of Medicine, Turkey
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Tekdemir I, Aslan A, Elhan A. A clinico-anatomic study of the auricular branch of the vagus nerve and Arnold’s ear-cough reflex. Surg Radiol Anat 1998. [DOI: 10.1007/s00276-998-0253-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tekdemir I, Aslan A, Elhan A. A clinico-anatomic study of the auricular branch of the vagus nerve and Arnold's ear-cough reflex. Surg Radiol Anat 1998; 20:253-7. [PMID: 9787391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The results of a clinico-anatomic study of the auricular branch of the vagus nerve (ABVN) and Arnold's ear-cough reflex are presented. The frequency of the ear-cough reflex was found to be 2.3% (12 out of 514 patients). It was bilateral in 3 cases (0.6%). The reflex was elicited by palpation of the postero-inferior wall of the external acoustic meatus (EAM) in 11 patients, and by palpation of the antero-inferior wall in one patient (0.2%). The reflex was frequently noticed to occur after a short latent period. The course of the ABVN inside the jugular foramen (JF), and distribution of the terminal branches of the ABVN in the external acoustic meatus were determined in 8 male cadavers (16 sides). In addition, the length of the mastoid canaliculus (MC) and the relationships of the ABVN with the facial nerve and stylomastoid foramen (SMF) were studied in both cadavers and 25 dry skulls (50 sides). High-resolution computed tomography (HRCT) scanning was also performed in all cadavers prior to microdissections. The ABVN emerged from the superior ganglion of the vagus nerve in all the cadavers. It ran between the internal jugular vein (IJV) and the bony wall of the jugular foramen. The ABVN was encased in a partial bony canal during its course from the jugular foramen to mastoid canaliculus in 18% of all specimens. The average length of the mastoid canaliculus was 5.6 mm (4.2-6.5), and it ran transversely towards the tympanomastoid suture 4.5 mm (4-5.1) above the stylomastoid foramen. The mastoid canaliculus was well demonstrated in all the HRCT scans.
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Affiliation(s)
- I Tekdemir
- Anatomy Department, Ankara University School of Medicine, Sihhiye, Turkey
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Tekdemir I, Tüccar E, Cubuk HE, Ersoy M, Elhan A, Deda H. Branches of the intracavernous internal carotid artery and the blood supply of the intracavernous cranial nerves. Ann Anat 1998; 180:343-8. [PMID: 9728276 DOI: 10.1016/s0940-9602(98)80040-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
With the increasing frequency of surgical operations to the cavernous sinus greater knowledge of the microanatomy of the cavernous sinus has become necessary. The most frequently seen complications during cavernous sinus surgery involve impairment of cranial nerves. This can occur due to direct damage or ischemia. For these reasons, it is important to know the arterial supplies to the cranial nerves in the cavernous sinus and the anatomy of these branches as well. 15 formaline fixed adult cadavers were used in this study. Before the dissections, the internal carotid artery and vertebral artery were filled with coloured latex on both sides. In this report, the intracavernous branches of internal carotid artery (I.I.C.A.) were identified based on the principles of Nomina Anatomica (1989) and compared with others. In our study we found that the segment of the abducens nerve which lies in Dorello's channel was supplied by the meningeal branch; from the point at which it pierces the cerebellar tentorium, the trochlear nerve is supplied by the tentorial cerebellar artery; the posterior cerebellar artery supplies the proximal segment of the oculomotor nerve that proceeds to the oculomotor triangle. Except for these, all the cranial nerves that were located on the lateral wall of the sinus cavernosus are supplied by the tentorial marginal branch and the branches of the lateral trunk.
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Affiliation(s)
- I Tekdemir
- Ankara University, Faculty of Medicine, Department of Anatomy, Morfoloji Binasi, Turkey
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Abstract
Our study was aimed to examine the anatomic relationships of the tympanic branch of the glossopharyngeal nerve (GPN), namely the Jacobson's nerve (JN). The JN is the first branch of the GPN after having passed the jugular foramen. It contributes to the tympanic plexus on the promontory. It transmits secretory innervation to the parotid gland. Its possible role in the regulation of the middle ear pressure has also been hypothesized in terms of animal studies. Using microdissection techniques and high-resolution computed tomography (HRCT) scanning, the anatomic relationships and course of the JN were examined in eight formalin-preserved cadavers (16 sides). A morphometric analysis related to the JN was also performed both in the 16 cadavers and 40 dry-skull specimens. The JN emerged from the inferior ganglion of the GPN in all specimens. The mean distance between the ganglion and the genu of the GPN was 11.3 mm. The inferior 2/3 of the tympanic canal (TC) followed a vertical course, and then it ran anteromedially with an angle of 160 degrees to 170 degrees. The mean length of the TC was 9.5 mm. The TC was well-defined in all axial HRCT scans. In 2 cases the JN was entirely encased in a bony canal in the middle ear. A double JN was observed in one case. This study gives an additional information regarding the anatomy of the JN.
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Affiliation(s)
- I Tekdemir
- Department of Anatomy, Ankara University School of Medicine, Sihhiye, Turkey
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Ocakçioglu A, Yavuzer S, Yaman A, Elhan A. The effects of anti-NGF on the spatial learning and memory. Pathophysiology 1998. [DOI: 10.1016/s0928-4680(98)81135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Abstract
The peripheral, extraparotid course and localisation of the marginal mandibular branch of the facial n. is described, with variations, based on the dissection of 40 cadaver half heads. Its anatomical relationships with the ramus of mandible and facial a. are studied and morphometric features are reported. Knowledge of the accurate course and relationship of the marginal mandibular branch should help to protect this nerve from surgical injury.
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Affiliation(s)
- R Basar
- Department of Anatomy, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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