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Giriş ve Amaç: Takıma dayalı öğrenme (TDÖ) yöntemi öğrenci merkezli bir aktif öğrenme yöntemidir. Acıbadem Üniversitesi Tıp Fakültesi 2. sınıfında İskelet Sistemi Anatomisi eğitiminde TDÖ yöntemi uygulanmıştır. Bu çalışmanın amacı, uygulanan TDÖ yöntemi ile yürütülen anatomi dersi eğitiminin etkinliğinin değerlendirilmesidir.Yöntem: Kas-İskelet Sistemi Hastalıkları komitesi başlangıcında İskelet Sistemi Anatomisi dersi için takıma dayalı öğrenme yöntemi 2. sınıf öğrencilerine tanıtıldı. Uygulama öncesi sınıf mevcudu olan 88 öğrenci 8 takıma ayrıldı. Dört entegre TDÖ oturumu planlandı ve her bir oturum bireysel hazır bulunuşluk testi ile başladı. Devamında yapılan takım hazır bulunuşluk testi ile sonlandırıldı. Sonrasında öğrencilere anatomi laboratuvarında kadavra ve maket üzerinde uygulama yaptırıldı ve eş zamanlı konuya dair sorular yöneltildi. TDÖ uygulamasının son günü öğrencilere eğitim süreci hakkında geri bildirimlerini içeren bir soru formu dağıtıldı. Takıma dayalı öğrenme yöntemi ile ilgili geri bildirimlere verilen öğrenci yanıtları toplandı. Öğretim üyelerinin TDÖ yöntemi ile gerçekleştirilen uygulamalar hakkındaki görüşleri de yüz yüze görüşme yöntemi ile alındı. Anket sonuçları SPSS programında Pearson’ın korelasyon testi ile değerlendirildi. Bulgular: Öğrencilerin eğitim uygulaması hakkındaki olumlu görüşleri ile takım çalışmasının etkinliğine yönelik görüşleri pozitif yönde anlamlı bir korelasyon ilişkisi göstermiştir (p, Backgrounds: Team based learning (TBL) is an active learning method. In the 2nd grade of Acibadem University Faculty of Medicine, it was applied in Skeletal System Anatomy training. The present study aims to evaluate the efficiency of skeletal system anatomy courses which are given by using TBL method as a teaching tool. Methods: In the beginning of Muscle and Related Disorders Committee, the TBL method regarding anatomy lectures, was introduced to year 2 medical students. 88 students were divided into 8 groups. Four integrated TBL sessions were planned and each session began with an individual readiness assurance test followed by a team readiness assurance test. Afterwards, laboratory sessions were held in which teams had the chance to examine both the cadavers and anatomic models. The laboratuary sessions were ended with an individual oral examination. At the end of last TBL session a feedback questionnaire was given to the all students in order to evaluate students perceptions about Anatomy TBL experience. TBL perceptions of faculty members were gathered with face to face feedback meetings. The obtained data were statistically analyzed by Pearson’s correlation test. Results: Students' positive opinions about educational practice and the effectiveness of team work showed a positive correlation relationship (p

To determine the morphological features of the denticulate ligament in fetal period. Twelve formalin-fixed fetuses (six females and six males) with a mean gestational age of 27.0 ± 2.04 weeks (range between 25 and 32 weeks) were dissected to reveal morphological properties of the denticulate ligaments. Denticulate ligament was observed as a continuous ligament extending throughout the length of spinal cord in all fetuses. It separated the vertebral canal into two as anterior and posterior parts and was anchored to the dura mater on either side of the spinal cord with mostly triangular processes as well as thin band-like extensions. The first denticulate ligament process was always a large and prominent fibrous band and was arising from the spinal cord surface, extending in an oblique direction upward to the anterolateral rim of foramen magnum, below and posterior to the hypoglossal canal. The last denticulate ligament process was observed either in the T11–12 (2 sides, 8%), T12–L1 (15 sides, 62%) or L1–2 (7 sides, 30%) and all were band-like processes. At certain spinal cord levels, denticulate ligament had no processes to attach duramater while in some other fetuses double denticulate ligament processes were detected within the same interval. The distance between the denticulate ligament process and the superior spinal nerve root and the distance between the denticulate ligament process and the inferior spinal nerve root were measured at each spinal level. This distance was found to be increased from upper to lower levels of the spine. Detailed morphological data about fetal denticulate ligament presented in this study provide significant information which may be essential during several surgical interventions performed in early postnatal period and childhood focusing on the spinal cord, spinal nerve roots and meningeal structures.

To determine the incidence of the iliocapsularis muscle in fetal period and its relationship with the hip joint capsule. Twenty-one formalin-fixed fetuses (12 female and 9 male) with a mean gestational age of 29 ± 3.89 weeks (range 25–36) were dissected to reveal morphological properties of iliocapsularis muscle. Iliocapsularis muscle was observed in 39 out of 42 sides (92%). Its proximal attachment was detected either below the proximal attachment of rectus femoris muscle in 21 out of 39 sides (54%), or it was forming a common tendon with rectus femoris on the anterior inferior iliac spine in 10 out of 39 sides (26%), or it was forming an arch along the superior–medial–inferior sides of the proximal attachment of rectus femoris muscle in 8 out of 39 sides (20%). Muscle fibers originating from the anteromedial part of hip joint capsule were also constant in all sides. Distal attachment of iliocapsularis muscle was distal to the lesser trochanter in all specimens. Its form was as a broad muscle in 32 out of 39 sides (82%) and as a thin rectangular muscular slip in 7 out of 39 sides (18%). Iliopsoas and iliocapsularis muscles had their particular fascia in 34 out of 39 sides (87%), and in the other 5 sides, there was no fascia which prominently separated the two muscles. Its length was longer in females than males (p = 0.031) and it was wider on the right side (p = 0.029). Linear functions were y = 0.49 + 0.17 × weeks and y = 6.94 + 0.89 × weeks for width and length, respectively. Data obtained with the present study about iliocapsularis muscle in fetal period revealed that it is an individual and constant muscle. Its dimension, location, and course over the hip joint capsule support the idea that it tightens the hip capsule and stabilizes the femoral head.

This study aimed to determine the precise localization and course of parotid duct based on morphometric data obtained by measurements regarding several superficial landmarks and lines. Totally, 46 parotid ducts of 24 formalin-fixed adult amputated heads (12 female and 12 male) aged between 45 and 92 years, present in the collection of Anatomy Department, School of Medicine, Mersin University, were evaluated. First, three reference lines were defined: L1: between intertragic notch and labial commissure, L2: between intertragic notch and nasal wing, and L3: between intertragic notch and lateral palpebral commissure. The location of the parotid duct with respect to these lines were recorded. In all sides, parotid duct was detected in the middle 1/3 of L1. In 71.7% of all hemifaces, the parotid duct was making an upward curve around L1. Its proximal end exiting from the anterior border of the parotid gland was 12.34 ± 28.83 mm below the proximal 1/3 point of L1. Then, it was crossing L1 at a point with a mean distance of 53.90 ± 9.69 mm from the labial commissure where it is almost at L1 midpoint. Its distal end was located 9.61 ± 2.88 mm above the distal 1/3 point of L1. In 21.7% of all hemifaces, PD was observed totally above L1, while the shortest distances of its proximal and distal ends to L1 were 4.35 ± 2.45 mm and 13.17 ± 4.52 mm, respectively. In 6.5% of all hemifaces, its proximal end was located just on L1, coursing upwards and terminating 11.76 ± 2.53 mm above L1.

The aim of this study was to obtain information by assessing the relationship between temporal region fascial structures, fat pads, and temporal branches of facial nerve in human fetuses to use the knowledge on treatment of early childhood period surgeries. This anatomic dissection study was conducted on 40 hemifaces with no visible external abnormalities on their faces. Fascial layers and related fat pads of temporal region were dissected layer by layer beginning from superficial to deep. The relations of temporal branches of facial nerve and temporoparietal fascia and the structures of these fascial layers were evaluated. Temporoparietal fascia showed continuity below zygomatic arc with superficial musculoaponeurotic system. Temporal branches of facial nerve showed a multiple branching. Parotid-masseteric fascia became very thin on the superficial of zygomatic arch and ran with superficial layer of temporal fascia above without attaching to periosteum. Temporal branches of facial nerve entered between multilayered layers of temporoparietal fascia. Temporoparietal fascia became thicker on anterior and middle parts because of the localization of superficial temporal fat pad. Temporal fascia was a 2-layered thick and fibrous tissue enveloping intermediate fat pad. Deep layer connected to periosteum of zygomatic arch and superficial layer continued passing superficial of zygomatic arch and connected to the parotid-masseteric fascia. Deep temporal fat pad was found on the deep to deep layer of temporal fascia and surface of temporal muscle. The findings of this study may contribute to the knowledge of the topographical localization of temporal branches of facial nerve with temporal region fascial structures and fat pads in fetuses.

Objectives: Today, the internal thoracic artery and great saphenous vein are the most used coronary bypass grafts. Patency of the arterial grafts is better than vein grafts. Alternative arterial grafts are needed in the following cases: when the internal thoracic artery and great saphenous vein cannot be used or they were used in the previous operations, when more than one coronary artery is needed for grafting, or more than one graft is neded at the operation.Material and Methods: This study aims to reveal whether lateral thoracic and thoracodorsal arteries taken from 9 male cadavers at 56,67±6,38 years old, bilaterally are available to be used as a graft in coronary bypass surgery. The morphologic properties (length, lumen diamater, thickness of tunica intima and media, properties of internal and external elastic lamina, elastic and smooth muscle component of tunica media) of the proximal, middle and distal parts of these arteries are compared with internal thoracic, radial and coronary arteries’s (anterior interventricular branch, circumflex branch, right coronary artery).Results: It is determined that the lateral thoracic and thoracodorsal arteries have well-developed internal elastic lamina. Furthermore thickness of tunica intima and externa of the lateral thoracic and thoracodorsal arteries are observed to be similar or thinner than of the internal thoracic and radial arteries. These data are evaluated as positive properties in terms of using both of these arteries as graft in coronary bypass surgery.Conclusions: Length and lumen diameter of thoracodorsal artery are found adequate while lateral thoracic artery is not found adequate for single free graft. Neverthless, both of these arteries are found suitable to be used as composite grafts (as Y graft) with other grafts in terms of lenght and lumen diameter.

To determine the microsurgical features of the spinal cord and ventral and dorsal rootlets in fetal period. Twelve formalin-fixed fetuses (six females and six males) with a mean gestational age of 27.0 ± 2.04 weeks (range between 25 and 32 weeks) were dissected to evaluate morphological properties of the spinal cord and rootlets. Length and width of each spinal cord segment, number of dorsal and ventral rootlets, length of dorsal root entry and ventral root exit zones of each spinal nerve, spinal cord termination level, and the whole spinal cord length were determined in all fetuses. Contrary to previous reports, the number of ventral rootlets was always more than that of dorsal rootlets in all segments. No statistically significant gender difference was found for all parameters. Rootlet number and segment width in cervical region were larger than those of thoracic, while the lengths of dorsal root entry and ventral root exit zones in thoracic region were longer than those of cervical. In lumbar region, dorsal and ventral rootlet numbers were increasing again, while lengths of dorsal root entry and ventral root exit zones were decreasing. Number of dorsal and ventral rootlets of C5 and C6 segments was statistically higher than other cervical segments. The mean spinal cord length was found as 105.55 ± 11.30 mm and there was a positive significant relationship with gestational age. Conus medullaris level was detected between L1 and L3 segments. Detailed microsurgical data about the fetal spinal cord and the dorsal and ventral rootlets presented in this study provide significant information which may be essential during surgical interventions in early postnatal period and childhood targeting the spinal cord and spinal nerve roots.

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.

The aims of the study are to define anatomy of the facial nerve (FN) and its main trunks as well as their relationship with the posterior auricular artery in fetal period to evaluate the data for regional surgery in newborns and young infants. Formalin-fixed 34 fetuses from anatomy laboratory collection with a mean gestational age of 26.4 ± 4.6 (20–36) weeks were dissected. Parameters regarding the presence of major or minor trunks, width, length, branching pattern of FN were evaluated according to side, gender and trimester. The positional relationship of posterior auricular artery with the FN trunk was inspected. On all sides only the major trunk of the FN was detected. For length and width parameters, there was no statistically significant difference for side and gender except for trimester. Linear functions were found as 0.329 + 0.025 × weeks for width and 5.264 + 0.185 × weeks for length. There are statistically significant linear relationships between width and length of the FN trunk and week parameters as r = 0.507, p

Objectives: The anatomical relationship of the fibrous structures in the posterolateral corner of the knee is highly complex, with many different descriptions of these structures in the literature. Discrepancy in the definitions of FF, AL and PF are a problem for both clinicians and anatomists. This study aimed to examine these structures and describe their features to clarify our understanding of their morphology. Methods: The posterolateral corner of the knee joint was bilaterally dissected in 10 male cadavers. Fibrous structures originating from the fibular head as a common mass were defined in relation to their attachment sites and positions according to the inferior lateral genicular vessels. The fabellofibular ligament (FF) was grouped into two categories, depending on the presence of a dense, fibrous tissue band. The arcuate popliteal ligament components were grouped into superficial (ALs) and deep (ALd) by their position relative to the inferior lateral genicular vessels. The popliteofibular ligament (PF) was identified as the fibrous bundle attached to the inferior border of popliteus tendon (PT). Dimensions of these structures were measured, and statistical analyses undertaken using paired and independent t-tests (p

PMID: 29509842 Background: Inadequate release of retaining ligaments during facelift surgery may lead to an unnatural appearance. However, most facelift surgeons are hesitant in transecting these ligaments to avoid possible injury to facial subbranches. Objectives: In the authors’ surgical practice for modified composite flap rhytidectomy, the authors employed the finger-assisted malar elevation (FAME) technique in order to enable safe release of the zygomatic cutaneous ligaments through the prezygomatic space under direct vision. The aim was to evaluate the anatomical basis and safety measures of this technique through a cadaveric dissection study. Methods: Modified composite-flap facelift with the FAME technique was carried out in 22 fresh cadaver hemi-faces. All facial nerve subbranches were dissected thoroughly to assess for any evidence of injury during facelift, and to evaluate the safety of the operation. The relations among the facial nerve, zygomatic cutaneous and masseteric ligaments, orbicularis oculi muscle, and malar fat pad were investigated. Results: Finger dissection of the prezygomatic space allows safe release of the zygomatic cutaneous ligaments as well as adequate entry to a proper surgical plane above the zygomatici muscles under direct vision, while leaving the malar fat pad and overlying structures attached to the skin without the need of a transblepharoplasty approach. Conclusions: This study by the authors shows that a modified composite-flap facelift with FAME technique is a safe procedure that allows adequate and effective repositioning of an en-bloc composite flap that produces balanced and harmonious rejuvenation of the midface and lower face without the need of a separate midface lift.

Background As the skull base has a complex anatomy, we underline the importance of anomalies for side asymmetry. It is useful to investigate relationship between anatomical structures for the surgical procedure orientations. Dural adherence, enlarged superior petrosal sinus, influence of neural crest cells, and cranial base ossification are among the factors in morphometric growth on skull base. Material and methods Twenty-five fetuses of an estimated gestational age ranging from 17 to 34 weeks were studied in the Anatomy Laboratory of Mersin University Medical Faculty. Craniotomy was made to each fetus and brain hemispheres were dissected. We put plates, passing from the external points of lateral and anterior-posterior borders of fetus heads that are perpendicular to each other. An analytical calculation was formulated for the angle of foraminae to the root of zygoma by using different formulations depending on their posterior or anterior location to the root of zygoma. Statistical method was based on correlation analysis, simple regression, independent 2 group t tests, SPSS20.0, and MedCalc 11.5 (MedicReS, New York, NY). Results Neither side dominance for the jugular foramen, nor the differences of foramen rotundum, spinosum, and ovale to anterior skull wall, root of zygoma, and to midline were found to be significant. Conclusion There is a debate on asymmetry of foramina of the skull base. No certain consensus about the initiation time and the causes of asymmetry in the past was documented. Studies are to be encouraged to further enlighten pre-postnatal factors affecting the fetal skull base morphometrism.

To reveal the detailed morphological features of the fibular collateral (fibular) ligament, popliteus tendon, popliteofibular ligament and the synovial components regarding to achieve data for surgical and biomechanical utilization. Knees of 10 formalin-fixed male cadavers were dissected bilaterally. Bursae around the lateral collateral ligament and the relation of popliteus tendon with lateral collateral ligament at the femoral attachment site were noted. The positional relation between both ends of popliteofibular ligament was evaluated statistically. The PT exceeded the anterior margin of lateral collateral ligament in 11 sides, the posterior margin of lateral collateral ligament in 3 sides and exceeded both the anterior and posterior margins of lateral collateral ligament in 5 sides. The shape of lateral collateral ligament was narrower at the lower part than the upper in 14 sides. The width of lower part of lateral collateral ligament was found narrower in the cases with sheath-like bursa (vagina synovialis). The relation between both ends of popliteofibular ligament was as followed: the more anteriorly the fibular head attachment was located, the more anteriorly popliteofibular ligament was attached to the popliteus tendon. To resolve the posterolateral corner of the knee with regard to surgical anatomy and biomechanics, individual and concerted morphometric characteristics of lateral collateral ligament, popliteus tendon and PF should be evaluated together with accompanied synovial structures.

The relationship of facial nerve (FN) and its branches with the retromandibular vein (RMV) has been described in adults, whereas there is no data in the literature regarding this relationship in fetuses. The study was conducted to evaluate the anatomic relationships of these structures on 61 hemi-faces of fetuses with a mean age of 26.5 ± 4.9 weeks with no visible facial abnormalities. The FN trunk was identified at its emergence at the stylomastoid foramen. It was traced till its ramification within the parotid gland. In 46 sides, FN trunk ramified before crossing RMV and ran lateral to it, while in 8 sides FN trunk ramified on the lateral aspect of the RMV. In 3 sides, FN trunk ramified after crossing the RMV at its medial aspect. In only 1 side, FN trunk trifurcated as superior, middle, and inferior divisions and RMV lied anterior to FN trunk, lateral to superior division, medial to middle and inferior divisions. In 2 sides, FN trunk bifurcated as superior and inferior divisions. Retromandibular vein was located anterior to FN trunk, medial to superior division, lateral to inferior division in both of them. In 1 side, RMV ran medial to almost all branches, except the cervical branch of FN. Variability in the relationship of FN and RMV in fetuses as presented in this study is thought to be crucial in surgical procedures particularly in early childhood.

This study aims to obtain clues about the beliefs of medical students on learning anatomy through metaphor analysis which has not been used in this field before.A questionnaire was given to 174 medical students. Students were asked to complete the statement with a metaphor and to provide an explanation for it. All metaphors were grouped under 8 categories.The most frequently produced metaphors were collected in two categories, namely "being lost/unknown situation" and "hopeless struggle." These were the positions in which students feel themselves desperate, confused and lost (25%) or they consider their efforts to learn anatomy as an activity that is waste of time, ineffectual, and hopeless (24%). Only three out of eight categories (26%) had positive connotation.Metaphors acquired here reflect distress in anatomy learning. These results would direct the educators to revise educational methods and instruments to provide more efficient anatomy education.

In this study, we evaluated the effects of trapidil on crush injury by monitoring nitric oxide, malondialdehyde and transforming growth factor-Beta2 levels and by transmission electron microscopy in the rat sciatic nerve. The sciatic nerve was compressed for 20 sec by using a jewelers forceps. Trapidil treatment groups were administrated a single dose of trapidil (8 mg/kg) intraperitoneally just after the injury. The crush and crush + trapidil treatment groups were evaluated on the 2nd, 7th, 15th, 30th and 45th days of the post-crush period. On the 7th and 15th days, damage in thin and thick myelinated axons, endoneural edema and mitochondrial swelling were less severe in the trapidil group histopathologically. These findings supported the idea that trapidil prevented cell damage and edema at the injury site. Day/group interaction with regard to serum nitric oxide, malondialdehyde and transforming growth factor-Beta2 levels did not show significant changes.

Anencephaly occurs in 1:1,000 to 1:20,000 infants who are potential donors in pediatric heart transplantation, so it is important to define any morphologic differences between the anencephalic and normal heart in newborns. The dimensions of the heart in anencephalics, however, may differ. For example, the absence of cerebral tissue in anencephalic fetuses may decrease the heart load resulting in a smaller heart. The position of the heart in the thoracic cavity of an anencephalic fetus may affect the size and shape of the heart. This study compares the ventricular volumes and the inlet and outlet lengths of right and left ventricles in 11 normal and 11 anencephalic fetuses of gestational ages between 27 and 35 weeks. There was no statistically significant difference between the right ventricular volumes of normal and anencephalic fetuses, however, the difference between the left ventricular volumes was found to be almost statistically significant (P = 0.07). No statistically significant difference was found between the right and left ventricular volumes of normal fetuses; in anencephalic fetuses left ventricular volumes were found to be significantly smaller than right ventricular volumes (P = 0.05). The outlet length of the right ventricle and the inlet and outlet lengths of left ventricle in anencephalic fetuses were found to be short in comparison with those of normal fetuses (P = 0.01, P = 0.008, P = 0.01). It is proposed that anencephalics, because of these morphologic differences, should be reconsidered as possible donors for heart transplantation. Clin. Anat. 17:487–491, 2004. © 2004 Wiley-Liss, Inc.

Background:Organophosphate intoxication can cause some well-known life threatening acute neurological complications such as seizures, paralysis, neuromuscular and cardiac conduction disorders. Less often, a predominantly motor and delayed axonal neuropathy can occur. This syndrome is due to inhibition of neuropathy target esterase.Case Report:A 30-year-old woman attempted suicide by drinking approximately 1000mg/kg dimethyl-2,2-dichloro vinyl phosphate (DDVP). After a muscarinic and cholinergic syndrome lasting four days, she developed a purely motor distal axonal polyneuropathy on the fifth week after ingestion confirmed by electroneuromyography and sural nerve biopsy. Neurological examination and electroneuromyography revealed a slight recovery at the end of the 21st month.Conclusion:This case of late onset polyneuropathy caused by organophosphate intoxication had unusual features such as intact sensory nerves and worse prognosis when compared to previously reported cases.

There is detailed knowledge regarding the morphological features of the axillary nerve in adults, however, it in the fetal period we encountered no information. Brachial plexus injuries have been reported with a rate of 0.38-2.6 per thousand live births. Shenaq et al1 mentioned that the diagnosis, observation, and therapy are the initial approaches to these injuries, and should be initiated immediately. They also stated that early surgical intervention is essential to maximizing the long-term improvements in selected patients by helping to prevent residual growth deformities and underdevelopment of the affected limbs. The surgical treatment options include the reconstruction and neurotization.2 For the axillary nerve injuries, for example in case of C5-C6 avulsion, in which the upper roots have been avulsed from the spinal cord, and the clinical picture is that of a classic Erb palsy, they preferred to use neurotization technique. In this type of avulsion, the upper roots are not available as donors, and the C7-T1 roots are uninvolved. So, the suprascapular nerve is neurotized by the ipsilateral spinal accessory nerve, and the axillary nerve is neurotized by redundant branches to the triceps to ideally restore shoulder and elbow function. The thoracodorsal or the subscapular branches can also be neurotized to the axillary nerve to provide better shoulder function. Thus, anatomical details of the axillary nerve in fetal period become essential for such operations. We carried out this study to evaluate these parameters regarding the axillary nerve anatomy, which may be helpful to surgeons in certain conditions, such as end-to-side neurorrhaphy in brachial plexus reconstruction, neurotization, proximal humeral fracture repair, and shoulder dislocation treatment in the early childhood.

Objectives: The aim of the study was to evaluate the morphological features of the mediopatellar and lateral folds in fetal knees in the absence of any exposure to certain stress factors such as exercise or trauma. Methods: The study was performed in the knee joints of 15 fetuses (6 males, 9 females) obtained as spontaneous abortion material at 20-34 weeks of gestation. The mediopatellar and lateral folds of the fetuses were classified into eight subgroups according to the following morphological features: A- Absence of folds; B- Short vertical band; C- Long vertical band; D- Narrow horizontal band; E- Broad horizontal band; F- Horizontal band accompanied by a vertical band; G- Horizontal band without a vertical band; H- Fenestrated band. Results: The synovial membrane, covering the infrapatellar fat pad and forming the alar folds, extended upwards and formed the medial and lateral horizontal folds that covered the inferior part of the posterior aspect of the patella. These horizontal folds were thicker in the lower parts (close to their insertions) and became thinner towards the free ends. The horizontal band of the mediopatellar fold was observed in all cases, with an accompanying vertical band in 76.7% of the cases. A horizontally located lateral fold was absent in both knees of one fetus. The frequency of a horizontally located lateral fold was 93.3% and a vertical fold was accompanying in only 28.6% of these cases. It is of note that the horizontal band of the mediopatellar fold observed in all specimens has never been defined in previous classifications. In 10% of the knees, the vertically located part of the mediopatellar fold presented as a large band extending upward and being squeezed between the articular surface of the patella and the medial condyle of the femur. The lateral fold was observed as a large band in 10% of the knees. Another observation was that the higher level the vertical band of the mediopatellar and lateral folds began, the wider the horizontal band was, occupying more place in the patellofemoral space. It was remarkable that the frequencies of the vertically located parts of the lateral and mediopatellar folds in fetuses were higher than those reported for the adults in the literature. Conclusion: Our findings suggest that the resorption process of the mesenchymal tissue, particularly in the lateral part, continues until adulthood and causes age-dependent alterations in the formation of intra-articular folds. The synovial folds occupy more space between the patella and femur in the early stages of life than seen in adults. This may be a more frequent cause of unexplained knee pain in children than expected.

To define the detailed anatomy of the neurovascular bundle at the spinoglenoid notch and to report the dimensions of these structures in cadavers.In the present study, the external diameters of suprascapular artery, vein and nerve were measured at the spinoglenoid notch region in 18 formalin fixed cadavers (36 shoulders) by using a caliper. The study was carried out in the dissection laboratory of Anatomy Departments of Hacettepe University, Ankara University, Ankara and Mersin University, Mersin, Turkey, between 2002 and 2003.The average external diameter for the suprascapular vein was 2.6 mm, artery was 2.2 mm and nerve was 2.2 mm. The spinoglenoid notch was roofed by the spinoglenoid ligament and appeared as a fibroosseous foramen in all cadavers. We found that the vascular structures (suprascapular artery and vein) occupied 68.5% and the suprascapular nerve occupied 31.5% of this foramen.Although the diameters of the vascular structures at the spinoglenoid notch measured by magnetic resonance imaging have been reported, to our knowledge, external diameters of these structures at the spinoglenoid notch have not been described in cadavers. We believe that detailed anatomy of suprascapular neurovascular bundle at the spinoglenoid notch should be appreciated for better understanding of risk factors possibly causing the suprascapular nerve entrapment syndrome, specially for those who are involved in violent overhead sports activities such as volleyball and baseball.

During the dissection of an 80-year-old, white, male cadaver, a large scalenus minimus muscle was detected on the right side. Scalenus minimus muscle, a fiber bundle which strengthens the suprapleural membrane, arises from the anterior tubercle of the transverse process of the 7th cervical vertebra, and inserts to the inner border of the first rib and cupula pleura. In the present case, the scalenus minimus muscle on the suprapleural membrane was large on the right side. Its origin was on the anterior tubercle of the transverse process of the 7th cervical vertebra, and the muscle was located between the C7 and C8 anterior rami. The present case is noteworthy because of its great dimension and relation with the brachial plexus. Apart from its importance in cervical region anesthesia and surgery, such an anatomical structure can lead to several clinical conditions both by spasm and compression such as neurogenic thoracic outlet syndrome.

To determine whether the morphology and incidence of subtypes of the fetal suprapatellar fold are different from those of adults. Materials and methods: Suprapatellar folds of 30 fetal knees (6 male and 9 female fetuses, ages varying between 20 and 34 weeks of gestation) were classified according to their morphological features. Results: In 33.3% of the knees, the suprapatellar fold was forming an apparent barrier between the suprapatellar bursa and the main articular cavity. Vertical parts of the mediopatellar fold in 3 fetuses and lateral fold in 4 fetuses were coursing as the continuation of the suprapatellar folds. The suprapatellar fold, as an almost complete membrane, was more frequent in fetuses compared with those of adults reported previously. Conclusion: Our findings support the fact that the suprapatellar folds of the knee joint in early periods of life are different than those of adults. We consider that the resorption of the mesenchymal tissue, particularly on the lateral part, continues until adulthood and causes alterations in the formation of intraarticular folds. The results of this preliminary study suggest that knee pain caused by impingement of the complete suprapatellar fold and intermittent painful swelling of the knee by a valvular mechanism may be encountered more frequently in early periods of life than in adulthood.

Certain callosal dimensions, callosal areas, and the optic chiasm (OC) thickness were measured in order to detect any morphometric difference that would imply plastic changes in a selected group of adults.Seventeen early blinds were selected among a group of blind adults after performing interviews. These selected blind subjects, and 23 adults with normal vision of both genders were examined by MRI. The study was conducted in Mersin, Turkey between the years 2004 and 2006.Only 14 early blind subjects completed the MR imaging procedure. Statistically significant difference between the OC thicknesses of 2 groups was found whereas no statistically significant difference was detected for the callosal dimensions.The difference in the OC dimensions of the 2 groups may be explained by the disuse atrophy. It has been known that if a cortical area of any sense is deprived of stimulus within the critical period, then it may take on another cortical activity. The reasons for the unaffected dimensions of the corpus callosum (CC) in this study may be either the relatively small percentage of the fibers related to vision within the total CC, such as auditory function, of the "normally" visual cortex.

There are various data about the incidence of accessory tendons (AT) of extensor hallucis longus (EHL) muscle; however, their function is unknown. This study aimed to determine the incidence and morphometric features of the AT of EHL muscle in fetuses in order to provide more information to discuss its possible function. Forty-five fetuses (26 female and 19 male) were used in this study. Fetuses were grouped as Group A (16-21 weeks), Group B (22-27 weeks), and Group C (28-34 weeks) according to their age. In 23 (51%) out of 45 fetuses, there were AT. These were bilateral in 15 fetuses (65%) and unilateral in eight fetuses (35%). Fifty-two percent of the fetuses in group A, 43% in group B, and 67% in group C had AT. AT were observed in 14 female (54%) and 9 male (47%) fetuses. In all cases, the AT were always diverging to the medial side of the main EHL tendons and attached to the metatarsophalangeal joint capsule distal to the joint space. Significant correlations were observed in this study between EHL and AT widths as well as between EHL width and EHL-AT distance on both sides. The present study is the first to provide morphometric data about the AT of EHL muscle in fetuses which will be of use in understanding their function, particularly in biomechanics of the great toe.

Auditory cortices are interconnected to each other by fibers passing through the corpus callosum (CC). In totally deaf persons no auditory impulses are conveyed to the auditory cortices, hence the auditory pathways become nonfunctional. It was reported that there has been cross-modal plasticity between auditory, visual, and somatosensory cortices. In this study, our aim was to make a comparison in the CC morphometry in hearing subjects and in a selected group in which the auditory system was deprived before the age of 2. 18 deaf and 18 hearing male, handedness matched volunteers, ages varying between 28 and 56 years old were examined. Audiometrical tests were applied to both groups and then T1-weighted midsagittal MR images were obtained. Certain dimensions and areas were measured on these images. There were no statistically significant difference between deaf and hearing subjects, either when dimensions and areas were analyzed by multivariate analysis of variance or when areas were analyzed by univariate analysis of variance. Absence of any significant morphometric difference in the CC of deaf subjects could be thought as an evidence of reflection of functional cortical plasticity.

In this study, we focused on finding out whether branching patterns of the common fibular (CFN) and superficial fibular (SFN) nerves change throughout the early period of life. The popliteal fossa and legs on both sides of 20 fetuses (13 females and 7 males) were dissected. The ages of the fetuses varied between 20 and 36 weeks. The levels where the CFN diverged from the sciatic nerve, the CFN diverged to its terminal branches, and the cutaneous branches of the SFN became superficial and diverged were evaluated, together with the similarity of the patterns of these nerves on both sides. We observed that, comparing with the results of previous studies on adults, both the sciatic and the CFNs in the fetuses were diverging into their terminal branches more distally. Additionally, the SFN appeared to become superficial more proximally in the fetus than in the adult. SFN was piercing the crural fascia before diverging into its terminal branches in 29 legs. Only in 8 of them, it was becoming superficial within the middle one-third of the leg, which was observed more frequently in males (42.9% of 14 legs) than in females (13.3% of 15 legs). But there was no statistically significant gender difference (P ¼ 0.07). The medial dorsal cutaneous (MDCN) and intermediate dorsal cutaneous (IDCN) nerves which were piercing the crural fascia separately were observed in 27.5% of the subjects, all females. In these, MDCN was piercing the fascia superior to the level where the SPN becomes superficial, whereas the IDCN was piercing it to a level lower to this and always in the inferior onethird of the leg. We suggest that the detailed information about the branching patterns of the CPN and SPN in early ages will be beneficial, particularly in tumor and deformity surgery. The reason for different patterns and piercing levels of the nerves may be the effect of the elongating extremity during aging that enforces the fascia and modifies its position with a more stable structure, the nerve. Clin. Anat. 19:621–626, 2006. V C 2005 Wiley-Liss, Inc.

This report presents a rare example of a bilateral congenital anophthalmos and an agenesis of the optic pathways. The MR imaging studies revealed that the eyeballs, optic nerves, optic chiasm, optic tracts and optic radiation were absent. The chromosomal examination was normal. Mild mental retardation was also observed. Apart from the rarity of the anophthalmos and the total absence of the optic pathways, no etiologic reason for this pathology could be detected, which makes this case more significant.

Multiple variations of the deep artery of arm were observed during routine gross anatomic dissection of the right upper extremity of a 54-year-old male cadaver. In this case study, a double deep artery of arm and the deep artery of arm with the superior ulnar collateral artery were reported. The anatomic origin of the deep artery of arm is variable. In the literature, a double deep brachialis since its origin is reported in 0.7% and the deep brachial with the superior ulnar collateral artery in 22.3%. Such variations are considered to be occurring during embryologic development. These type of variations are important both in surgical and clinical situations.

Histopathologic changes in rat brain due to chronic use of morphine and/or tramadol in progressively increased doses were investigated in this study. Thirty male Wistar rats (180-220 g) were included and divided into three groups. Normal saline (1 ml/kg) was given intraperitoneally as placebo in the control group (n = 10). Morphine group (n = 10) received morphine intraperitoneally at a dose of 4 mg/kg/day for the first 10 days, 8 mg/kg/day between 11-20 days, and 12 mg/kg/day between 21-30 days. The tramadol group (n = 10) received the drug intraperitoneally at doses of 20, 40, and 80 mg/kg/day in the first, second, and the third 10 days of the study, respectively. All rats were decapitated on the 30th day and the brain was removed intact for histology. The presence and the number of red neurons, which are a histologic marker of apoptosis, were investigated in the parietal, frontal, temporal, occipital, entorhinal, pyriform, and hippocampal CA1, CA2, CA3 regions. Red neurons were found in morphine and tramadol groups but not in the control group. The total number of red neurons was not different in morphine and tramadol groups, but the numbers of red neurons were significantly higher in the temporal and occipital regions in tramadol group as compared with the morphine group (p < .05). In conclusion, chronic use of morphine and/or tramadol in increasing doses is found to cause red neuron degeneration in the rat brain, which probably contributes to cerebral dysfunction. These findings should be taken into consideration when chrome use of opioids is indicated.

When heart transplantation is needed in newborns, brain death should be confirmed, and the heart should not be exposed to hypoxia. The anencephalic newborn has been presented as a donor in heart transplantation. It is important, therefore, to evaluate possible morphological differences in the hearts of anencephalic cases. In this study, muscle fibers were studied in 10 anencephalic and 10 normal fetuses (27-35 weeks) and the results were compared. Random samples were taken from the upper 1/3 of the right ventricle's posterior wall and processed for light microscopic examination. Thicknesses of the 100 myocardial muscle fibers for each fetus were evaluated. There was statistically no significant difference between the anencephalic and normal fetus groups and the sex groups. Morphological features of the transplant probably affects the performance of the heart after operation. The anencephalic fetuses could be unique donors for heart transplantation.

Five cases are described where the first web space of the hand received arteries only from the superficial palmar arch. None of these branches was large enough to deserve the name “princeps pollicis artery”. These variations must be taken into account during surgical dissections of the hand.

In this study, 20 keratoconus corneal tissue were examined. In TEM examination of the cornea, the epithelium was irregular in thickness. In these epithelial cells, the number of microvilli were decreased and they showed an irregular arrangement. Vesicular degeneration and swelling of the mitochondria were observed in the cytoplasm of these cells. Interepithelial relation was normal and the desmosomes did not show any pathology. In the electron microscopic examination of the stroma, focal degeneration was observed in the collagen fibers. In SEM examination of the cornea, depressions and elevations were found on the epithelial surface. Additionally, degenerated epithelial cells were observed on focal areas. To our knowledge, the decreased number of microvilli and their irregular arrangement which we observed in TEM examination of the cornea epithelium were not reported in the literature.

We observed a bilateral and symmetrical variation of the anterior belly of the digastric muscle during the dissection of a 35-year-old female cadaver. The accessory muscle bundles were arranged in a cross. These bundles were found superficial to the mylohyoid muscle and deep in the platysma. Such a variation from perfect symmetry has not been previously reported. To avoid misinterpretation of radiological tests, it is important to be aware of bilateral and symmetrical variations of the anterior belly of the digastric muscle when examining the floor of the mouth and the submental region.