THE ROLE OF WOMEN IN THE TEACHING-RESEARCH IN TURKEY

There are 131 government, 75 private Universities in Türkiye. A demographic data on the number of women working as academic stuff in these Universites is missing and needs to be evaluated. However, the data related to Ankara University Faculty of Medicine show that on the number of female administrators and representatives in academic and administrative fields is higher than that of men.

EL ROL DE LA MUJER EN LA DOCENCIA-INVESTIGACIÓN EN TURQUÍA

Hay 131 universidades gubernamentales y 75 privadas en Türkiye. Faltan datos demográficos sobre el número de mujeres que trabajan como académicos en estas universidades y deben evaluarse. Sin embargo, los datos relacionados con la Facultad de Medicina de la Universidad de Ankara muestran que el número de mujeres administradoras y representantes en los campos académico y administrativo es mayor que el de los hombres.

Posteromedial Compartment Arthroscopy of the Knee and Resection of Osteophytes: An Anatomic Perspective on Posteromedial Knee Impingement

Posteromedial knee pain is a common clinical problem. It is often accompanied by degenerative changes or tears in the posterior horn of the medial meniscus and/or pain during deep flexion of the knee. In more advanced cases, it is accompanied by the osteophytic formation of a cam lesion that develops gradually in the posterior of the medial condyle of the femur and, with it (or less frequently without it), an osteophytic lesion at the posterior of the tibia (i.e. pincer lesion) occurs. It is believed that resection of the cam lesion may delay the progression of knee osteoarthritis, similarly to repairing the posterior horn of the medial meniscus. In this technical note, we describe a 2-portal technique for resection of cam lesions by posteromedial knee arthroscopy using anatomic landmarks. Using both portals provides better visualization and a better approach.

Cutaneous perforators of the arm and anatomical landmarks for defining the flap donor sites

PURPOSE

There are few studies searching for possible perforator flap donor sites on the arm. This study aimed to identify the locations of cutaneous perforators of the arm according to anatomical landmarks.

METHODS

Thirteen Thiel-fixed and latex-filled upper extremities of bodies donated to science were used. The distance between the acromion and medial or lateral epicondyle of the humerus was defined as the Y-axis, and the axis that cut the Y-axis perpendicularly through the epicondyles of the humerus was identified as the X-axis. The Y-axis was then divided into three parts Cutaneous arterial perforators were found using surgical dissection. The locations of the perforators were determined according to the defined lines and regions.

RESULTS

On the lateral side, there were 6.00 ± 2.08 perforators per arm, of which 56.4% were septocutaneous and 43.6% muscular. In all extremities, with in the distal 1/3 of the lateral arm, there were 1-4 radial collateral artery-based perforators. The mean distance of these perforators to the Y-axis was 1.16 ± 0.53 cm. On the medial side, there were 5.05 ± 1.44 perforators per arm, which were all septocutaneous perforators. In 85% of the extremities, within the middle 1/3 of the medial arms, there were 1-2 superior ulnar collateral artery-based perforators. The mean distance of these perforators to the Y-axis was 1.53 ± 0.61 cm.

CONCLUSION

There are always perforators from the radial collateral artery with in the distal third of the lateral arm. Within the middle third of the medial arm, it is usually possible to find a perforator from the superior ulnar collateral artery.

Standardized Statement for the Ethical Use of Human Cadaveric Tissues in Anatomy Research Papers: Recommendations from Anatomical Journal Editors-in-Chief

Human cadaveric donors are essential for research in the anatomical sciences. However, many research papers in the anatomical sciences often omit a statement regarding the ethical use of the donor cadavers or, as no current standardized versions exist, use language that is extremely varied. To rectify this issue, 21 editors-in-chief of anatomical journals, representing 16 different countries, developed standardized and simplified language that can be used by authors of studies that use human cadaveric tissues. The goal of these editor recommendations is to standardize the writing approach by which the ethical use of cadaveric donors is acknowledged in anatomical studies that use donor human cadavers. Such sections in anatomical papers will help elevate our discipline and promote standardized language use in others non anatomy journals and also other media outlets that use cadaveric tissues.

Acknowledging the use of human cadaveric tissues in research papers: Recommendations from anatomical journal editors

Research within the anatomical sciences often relies on human cadaveric tissues. Without the good will of these donors who allow us to use their bodies to push forward our anatomical knowledge, most human anatomical research would come to a standstill. However, many research papers omit an acknowledgement to the donor cadavers or, as no current standardized versions exist, use language that is extremely varied. To remedy this problem, 20 editors-in-chiefs from 17 anatomical journals joined together to put together official recommendations that can be used by authors when acknowledging the donor cadavers used in their studies. The goal of these recommendations is to standardize the writing approach by which donors are acknowledged in anatomical studies that use human cadaveric tissues. Such sections in anatomical papers will not only rightfully thank those who made the donation but might also encourage, motivate, and inspire future individuals to make such gifts for the betterment of the anatomical sciences and patient care.

Role of anatomic variations of paranasal sinuses on the prevalence of sinusitis: Computed tomography findings of 350 patients

OBJECTIVE

The aim of this study was to determine the frequency of anatomic variations of the paranasal sinuses and their roles in the development of sinusitis.

MATERIALS AND METHODS

Computed tomography of paranasal sinuses of 350 patients was assessed in terms of anatomic variations and inflammatory sinus pathology. The coexistence of anatomic variations with sinusitis was statistically investigated.

RESULTS

At least one anatomical variation of paranasal sinuses was detected in 325 patients (92.9%). In 297 (91.4%) of these patients, sinusitis was observed at rates varying depending on the types of anatomic variations. A statistically significant relationship was found between agger nasi cells, Onodi cells, hypertrophy of middle concha, concha bullosa, uncinate bulla, and the medial and lateral deviations of uncinate process and sinusitis. On the other hand, there was no statistically significant relationship between septal deviation, paradoxical middle concha, secondary middle concha, great ethmoidal bulla, and sinusitis.

CONCLUSION

Certain types of paranasal sinus variations create a susceptibility to sinusitis.

Insertional Characteristics of the Peroneus Tertius Tendon: Revisiting the Anatomy of an Underestimated Muscle

The present study was performed to describe the morphologic characteristics of the peroneus tertius (PT) tendon, evaluate the variations in its insertion point, investigate the interconnections with the tendons of the extensor digitorum longus, and discuss whether these insertion differences of the muscle tension might have an effect on fracture formation. The length and width of the PT tendon and the width at its midpoint were measured in 44 lower extremities. The data obtained were compared statistically. The PT was found to occur in 2 types according to the number of tendons: type 1, a single tendon without a slip; and type 2, 2 tendons with a slip. It has been suggested that the PT tendon could contribute to avulsion fractures of the tuberosity of the fifth metatarsal bone. Therefore, to understand the mechanism of Jones fracture, knowledge of the PT tendon would be beneficial to determine the insertion points.

Robotic hip arthroscopy: a cadaveric feasibility study

OBJECTIVE

The aim of this study was to test if robotic surgery can be used while performing hip arthroscopy.

METHODS

Hip arthroscopy was performed on two hip joints of a fresh-frozen male human cadaver. The arthroscopic control of the femoral head and neck and acetabular labrum were evaluated using the da Vinci Surgical System.

RESULTS

Docking of the robotic system and manipulation of the instruments were successful. Although most regions reached in standard arthroscopy were also reached with this robotic setting, the 5-mm instrument was limited in movement due to its long articulation section. The 8-mm instrument had shorter articulation section and exhibited a full range of motion inside the joints. The posterior part of the femoral head and the posteroinferior portion of the acetabular labrum could not be observed because of the rigidity of the equipment.

CONCLUSION

Robotic hip arthroscopy appears feasible in a cadaveric model but has some significant limitations. With the development of special instrumentations, arthroscopy of the large or small joints may be possible with robotic surgery. Robotic surgery may also enable surgeons to perform more complex and precise tasks in restricted spaces.

The fibular collateral ligament of the knee: a detailed review

The fibular collateral ligament (FCL) is one of the larger ligaments of the knee. The FCL, along with the popliteus tendon, arcuate popliteal ligament, and joint capsule, make up the posterolateral corner of the knee. Recently, there has there been an increased awareness and research on the structures of the posterolateral corner of the knee, particularly the FCL. Studying the detailed structure of the FCL may provide a better understanding that can lead to better diagnosis and treatments following injury. Therefore, this article reviews the FCL, which appears to be the primary restraint to varus rotation but is poorly oriented to resist external rotation of the knee.

Medical students' attitudes towards science and gross anatomy, and the relationship to personality

Assessment of the personalities of medical students can enable medical educators to formulate strategies for the best development of academic and clinical competencies. Previous research has shown that medical students do not share a common personality profile, there being gender differences. We have also shown that, for French medical students, students with personality traits associated with strong competitiveness are selected for admission to medical school. In this study, we further show that the medical students have different personality profiles compared with other student groups (psychology and business studies). The main purpose of the present investigation was to assess attitudes to science and gross anatomy, and to relate these to the students' personalities. Questionnaires (including Thurstone and Chave analyses) were employed to measure attitudes, and personality was assessed using the Big Five Inventory (BFI). Data for attitudes were obtained for students at medical schools in Cardiff (UK), Paris, Descartes/Sorbonne (France), St George's University (Grenada) and Ankara (Turkey). Data obtained from personality tests were available for analysis from the Parisian cohort of students. Although the medical students were found to have strongly supportive views concerning the importance of science in medicine, their knowledge of the scientific method/philosophy of science was poor. Following analyses of the BFI in the French students, 'openness' and 'conscientiousness' were linked statistically with a positive attitude towards science. For anatomy, again strongly supportive views concerning the subject's importance in medicine were discerned. Analyses of the BFI in the French students did not show links statistically between personality profiles and attitudes towards gross anatomy, except male students with 'negative affectivity' showed less appreciation of the importance of anatomy. This contrasts with our earlier studies that showed that there is a relationship between the BF dimensions of personality traits and anxiety towards the dissection room experience (at the start of the course, 'negative emotionality' was related to an increased level of anxiety). We conclude that medical students agree on the importance to their studies of both science in general and gross anatomy in particular, and that some personality traits relate to their attitudes that could affect clinical competence.

Does the sphenoid angle effect the operation strategy? Anatomical and radiological investigation

AIM

The aim of our study is to suggest the sphenoid wing-lesser wing angulation (SWA) importance during surgeries directed to this region.

MATERIAL AND METHODS

SWA on 40 skulls were measured bilaterally (n=80). The depth of the middle cranial fossa (DMCF) at the level of the SWA was determined. The same measurements were done on 40 randomly selected computerized tomography (CT) scans bilaterally (n=80).

RESULTS

The specimens were classified into 3 groups according the degree of SWA; Group-A, SWA was more than 130° (27%), Group-B, SWA was 110-130° (43%) and Group-C, SWA was less than 110° (28%). MCF was measured (mean) as 10.1 mm in Group-A, 6.4 mm in Group-B and 4.6 mm in Group-C. MCF was increasing with the increase in SWA. CT scans were classified into same procedure. Group-A was 26%, Group-B was 42% and Group-C was 31% fitting in the relevant groups. The superior orbital fissure (SOF) was evaluated according to the Sharma's classification.

CONCLUSION

We suggest that by the preoperative evaluation of CT scans measurements the SWA, it is possible to estimate the MCF and the type of SOF. This knowledge may be important for all surgeries requiring removal of the sphenoid wing and these region pathologies.

The adductor minimus muscle revisited

The adductor minimus muscle has had scant and conflicting reports regarding its anatomy with some authors ignoring its existence altogether. The present study was conducted to more precisely describe the anatomy of this muscle. Forty human cadavers underwent dissection of the posterior thigh for observation of the adductor minimus muscle. When identified, this muscle was measured and relationships to the muscle documented. Additionally, five fetuses were dissected to observe for the presence of the adductor minimus muscle. The adductor minimus muscle was found in roughly one half of our specimens and was seen in all fetal specimens. When absent, the quadratus femoris muscle was always more prominent and extended more inferiorly toward the territory of the adductor minimus muscle. The average maximal length, width and thickness for the adductor minimus muscle was 14.6 cm, 7 cm, and 2.25 mm, respectively. Such data may be of consequence to clinicians who rehabilitate posterior thigh musculature or surgeons who operate this region.

A review of the T2 segment of the brachial plexus

Although the complex architecture of the brachial plexus (BP) has been described for decades, recent literature still aims to elucidate the variation in nerve root contributions to the BP. Understanding this variability in the nerve morphology of the BP may assist physicians and surgeons in the diagnosis and management of certain clinical conditions that involve the BP, either directly or indirectly due to its close association with neighbouring structures. In this article, we review the current anatomical knowledge of the BP, focusing especially on its T2 contribution, and discuss the causes and consequences of some relevant BP pathologies.

Ossification of ligaments near the foramen ovale: an anatomic study with potential clinical significance regarding transcutaneous approaches to the skull base

OBJECTIVE

There is paucity of information regarding the specific anatomy and clinical significance of ossified ligaments near the foramen ovale (e.g., pterygospinous and pterygoalar ligaments). The present study was undertaken to define this anatomy in more detail and to review the literature regarding these anatomic variations.

METHODS

One hundred fifty-four adult human dry skulls were analyzed for the presence of ossified ligaments of pterygospinous (ligament of Civinini) and pterygoalar (ligament of Hyrtl). Measurements were made of these bony structures and observations made of their relationships to the inferior aspect of the foramen ovale and neighboring structures.

RESULTS

Two ossifications each (2.6%) of the ligaments of Civinini and Hyrtl were found. One of each of these (1.3%) was completely ossified, thereby resulting in 2 complete foramina (i.e., 1 foramen of Civinini and 1 foramen of Hyrtl). A significant correlation was found between the left and right sides, with either complete or incomplete ossification of these ligaments being found on left sides (75%) (incomplete Civinini on right side and all others on left side). The complete foramen of Civinini was found to have an area of 16.7 mm, and the complete foramen of Hyrtl was found to have an area of 9.42 mm.

CONCLUSION

Such anomalous bony obstructions could interfere with transcutaneous needle placement into the foramen ovale or distort anatomic relationships during approaches to the cranial base.

Princeps pollicis artery arising from the superficial palmar arch

We present a 48-year-old male cadaver in which the right superficial palmar arterial arch had no contribution from the radial artery and terminated by giving rise to a common trunk for the princeps pollicis and radialis indicis arteries. The dorsal radial artery of the thumb was absent and no arterial supply was provided by the radial artery. Accordingly, the entire arterial supply to the right thumb was provided by the superficial palmar arterial arch, which was composed solely of the ulnar artery, which received no collateral supply from the radial artery system. Considering that the arterial supply of the thumb in the present case was solely provided by the superficial palmar arch, a potential hazard could exist in the event of traumatic injury to the ulnar artery.

Anatomy of the lateral intermuscular septum of the arm and its relationships to the radial nerve and its proximal branches. Laboratory investigation

OBJECT

Other than very simple descriptions of the existence of the lateral intermuscular septum (LIS), the literature offers almost nothing about its detailed anatomy, relationships to the radial nerve, and proximal branches. To further elucidate its morphological characteristics, the present cadaveric study was performed.

METHODS

The lateral arm was bilaterally dissected from 25 adult fixed cadavers (50 sides). Specifically, a detailed evaluation of the LIS was made, and this structure's attachments and relationships to the radial nerve were analyzed and measured.

RESULTS

In addition to the previously described muscles arising from the LIS, the authors identified the extensor carpi radialis brevis muscles as partially arising from this structure. The deep and posterior portion of the deltoid tendon was confluent with the superior aspect of the LIS. The mean thickness of the LIS was 1.0 mm. Distally, the LIS attached strongly to the lateral epicondyle of the humerus and became confluent with the annular ligament encircling the head of the radius. The distal attachment of the LIS was confluent with the capsule of the elbow joint. All radial nerves traveled through a defect (mean diameter 1 cm) in the LIS. With traction on the nerve from proximal and distal to this defect, there was free excursion. In 85% of the specimens, however, the posterior antebrachial cutaneous nerve traveled through a tunnel within the LIS and pierced the septum at a mean of 5 cm proximal to the lateral epicondyle. The lower lateral brachial cutaneous nerve proximally pierced the LIS near its origin, occurring a mean of 3.2 cm distal to the LIS's origin from the humerus.

CONCLUSIONS

To the authors' knowledge, the details regarding the LIS and its relationships to the radial nerve have not been reported. Such information may be of use to surgeons who operate in this region, for example, during neural repair or entrapment procedures.

Regional anatomic structures of the elbow that may potentially compress the ulnar nerve

HYPOTHESIS

Traumatic injuries to the ulnar nerve at the elbow are a frequent problem as it is vulnerable to stretching and compression with motion of the upper limb. The aim of the present study was to explore the course of the ulnar nerve at the elbow and forearm and to determine possible anatomical structures that may cause compression of this structure.

MATERIALS AND METHODS

We examined 12 upper limbs from cadavers. The length of any fibrous bands, and if present, their distance to the medial epicondyle was recorded.

RESULTS

On 5 sides a fibrous band originating from the medial intermuscular septum was observed to cross over the ulnar nerve. The average length of the fibrous band was 5.7 cm, and it attached to the medial epicondyle. The mean length of the ulnar nerve as it coursed in the cubital tunnel was 3.8 cm. In 4 of the cases, the ulnar nerve was covered by muscle fibers originating from the flexor digitorum superficialis and extending to the flexor carpi ulnaris. On 5 sides we observed fibrous thickenings, and on 8 sides vascular structures were found crossing over the ulnar nerve.

DISCUSSION

The cubital tunnel is the most common site of compression of the ulnar nerve. Numerous surgical procedures are recommended for cubital tunnel syndrome. Simple decompression is used most commonly. Although surgical procedures are reported to provide efficient pain relief and functional recovery, residual or recurrent symptoms have been reported. Reasons for such recurrences may be more proximal or distal compression of the ulnar nerve as seen in our study.

CONCLUSION

Knowledge of possible compression sites of the ulnar nerve is important to the surgeon so that complications are avoided and postoperative recurrence is decreased.

LEVEL OF EVIDENCE

Basic science study.

Defining the macroscopic and microscopic findings of experimental focal brain ischemia in rats from a forensic scientist's point of view

Approximately 10% of all deaths in the world occur as a result of stroke. Determination of the time schedule of the pathologic events in a stroke patient is invaluable for a forensic specialist. The aim of this study was to define the schedule of the macroscopic and microscopic changes that occurred in a rat model of permanent focal ischemia for providing useful clues for the evaluation of stroke patients. Male Wistar rats weighing 250 to 350 g were used in this study. Permanent focal brain ischemia was applied by the suture occlusion method. The animals were divided into 7 experimental groups (n = 6) with time schedules including 1.5, 3, 6, 12, 24, 72 hours, and the sham. Brains were harvested at the end of the determined time schedule. Lesions in the frontoparietal cortex were evaluated macroscopically first and later hematoxylin eosin stained sections from the infarct core were investigated microscopically. Macroscopically, enlargement of the ipsilateral hemisphere was mild at 6 hour, apparent at 12 and 24 hours, and mild again at 72 hours. Microscopically, ischemic changes were apparent even at 1.5 hour. Red neurons and infiltration of the parenchyma with neutrophil leukocytes were observed at 12 hours. Pannecrosis and massive leukocyte infiltration were observed at 72 hours. Macroscopic and microscopic findings obtained from a rat model may provide clues for determination of the time-dependent changes due to brain ischemia in human subjects. Finally, the benefits of determination of time course of pathologic changes in the brain for forensic scientists were discussed.

Anatomy of the reflected ligament of the inguinal region

BACKGROUND

There is a paucity in the literature regarding the reflected ligament. Therefore, the present study was performed in order to further elucidate this anatomy.

MATERIAL AND METHODS

Eighteen formalin-fixed adult cadavers (35 sides) underwent dissection of the medial inguinal region. The reflected ligament was observed for and when identified, its dimensions were measured.

RESULTS

83% of sides were found to have a reflected ligament. These were identified in 16 male and 13 female bodies. The size and shape for the reflected ligaments were variable but overall, triangular in nature. In general, the reflected ligament was found to extend from the lacunar and medial inguinal ligaments and extended obliquely toward the midline at an approximate 45 degrees angle to insert near the linea alba. Two ligaments (6.9 %) were identified that interdigitated with the contralateral reflected ligament. The medial and lateral lengths of the ligament had a mean measurement of 2.28 and 2.58 cm. The base of the reflected ligament had a mean of 2.52 cm and the height of this ligament was found to have a mean of 2.56 cm. The mean area of the reflected ligament was calculated as 2.93 cm(2). There was no statistically significant difference between right or left sides or between genders.

CONCLUSIONS

The reflected ligament was identified in the majority of our specimens and this structure usually contributed to the formation of the posteromedial wall of the external inguinal ring. Therefore, this fact should be included in future descriptions of this ligament.

Arcuate line of the rectus sheath: clinical approach

The rectus sheath has been extensively described in gross anatomic studies but there is very little information available regarding the arcuate line (AL). The aim of the present study therefore was to explore and delineate the morphology, topography and morphometry of the arcuate line and provide a comprehensive picture of its anatomy across a broad range of specimens. The AL was present in all specimens examined. In addition, the AL was found to be located at a mean of 70.2% (67.3-75.2%) of the distance between the pubic symphysis and the umbilicus, and at 33.9% (30.2-35.4%) of the distance between the pubic symphysis and the xiphoid process. This location was found to be at a mean of 2.1 +/- 2.3 cm superior to the level of the anterior superior iliac spines. Furthermore, there were three distinct types of AL morphology. In type I (65%), the fibers of the posterior rectus sheath (PRS) gradually disappeared over the transversalis fascia, creating an incomplete demarcation of the actual location of the AL. In type II (25%) the termination of the fibers of the PRS was acutely demarcated over the transversalis fascia, creating a clear border with the AL. In type III (10%) the fibers of the PRS created a double and thickened aponeurotic line. In these cases a double AL was observed. Better preoperative knowledge of the location of the AL may, in some cases, help preoperative planning to facilitate primary fascial repair, which can then be supported with on-lay mesh, depending on the clinical situation.

Morphologic variation of the diaphragmatic crura: a correlation with pathologic processes of the esophageal hiatus?

The contributions of muscle fibers from the right and left diaphragmatic crura to the formation of the esophageal hiatus have been documented in several studies, none coming to a complete consensus on the number of anatomic variations or the prevalence of these variations in the human population. These variations may play a role in the pathogenicity of specific diseases that involve the esophageal hiatus, such as hiatal hernias. We examined a total of two hundred adult cadavers during 2000-2007. The variations in the diaphragmatic crura, particularly their muscular contributions to the formation of the esophageal hiatus, were grossly examined and revealed a bilateral occurrence of diaphragmatic crura in all 200 specimens. The results of the various morphological patterns of circumferential muscle fibers forming the esophageal hiatus were classified into six groups. The most common type (Type I, 45%) formed the esophageal hiatus from muscular contributions arising solely from the right crus. In Type II (20%) the esophageal hiatus was formed by muscular contributions from the right and left crura. In Type III (15%), the right and left muscular contributions arose from the right crus with an additional band from the left crus. Type IV (10%) showed that the right and left muscular contributions arose from the right crus, with two additional (anterior and posterior) bands arising from the left crus. Type V (5%) demonstrated the contributions arising solely from the left crus. In Type VI (5%) the right and left contributions originated from the left crus with two additional bands, one from the right crus and one from the left crus. These variations may play a role in the pathogenicity of specific diseases that involve the esophageal hiatus such as hiatal hernia, gastroesophageal reflux disease and Dunbar's syndrome.

Lateral lakes of Trolard: anatomy, quantitation, and surgical landmarks. Laboratory investigation

OBJECT

There is scant and conflicting information in the literature regarding the lateral lacunae, or lateral lakes of Trolard. As these venous structures can be encountered surgically, this study aimed at further elucidating their anatomy, identifying surgical landmarks, and associated quantitation.

METHODS

Thirty-five adult cadavers were dissected of lateral lacunae. Following quantitation of the lacunae, these structures were measured, as were the distances from them to the coronal and sagittal sutures.

RESULTS

A mean of 1.9 lacunae were identified on the right sides and 1.4 lacunae on the left sides. Although there tended to be slightly more lacunae on the right sides, this difference did not reach statistical significance (p > 0.05). The average lengths of the lacunae were 3.2 and 2.0 cm for the right and left sides, respectively. The mean widths of these venous lakes were 1.5 cm for the right sides and 0.8 cm for the left sides. Lacunae were variably positioned but tended to cluster near the vertex of the skull. None were identified posterior to the lambdoid sutures, and only 5 were found to lie anterior to the coronal suture, with 4 of these located on right sides (p < 0.05). When lacunae were identified anterior to the coronal suture, they were generally 5-6 cm from this structure. The majority of lacunae could be identified between the coronal and lambdoid sutures and within 3 cm of the midline.

CONCLUSIONS

Although the situation varies, lateral lacunae are concentrated posterior to the coronal suture and anterior to the lambdoid sutures. They are most often found within 3 cm of the sagittal suture. These previously unreported data could be useful to the neurosurgeon in planning surgical procedures that traverse the calvaria.

Costanzo Varolio (Constantius Varolius 1543-1575) and the Pons Varolli

COSTANZO VAROLIO (CONSTANTIUS Varolius) (1543-1575) was born in Bologna and died in Rome. This professor of anatomy and papal physician was the first to examine the brain from its base up, in contrast with previous dissections of this organ performed from the top down. Varolio was the first to describe many structures, including the pons, which is still known today as the pons Varolli. Varolio was a pupil to the well-known anatomist Aranzio, who was in turn a pupil of Vesalius. Our current understanding of the nervous system is based on the early anatomic descriptions and depictions by such individuals as Varolio.

Contributions of the fourth spinal nerve to the brachial plexus without prefixation

Object

The intradural contributions of the C-4 nerve rootlets have not been previously evaluated for their connections to the brachial plexus. The authors undertook a cadaveric study to evaluate the C-4 contributions to the upper trunk of the brachial plexus.

Methods

The posterior cervical triangles from 60 adult cadavers were dissected. All specimens that were found to have extradural C-4 contributions to the upper trunk of the brachial plexus were excluded from further study. In specimens found to have no extradural C-4 contributions to the brachial plexus a C1–T1 laminectomy was performed. Observations were made of any neural communications between adjacent spinal rootlets, specifically between C-4 and C-5.

Results

Nine (15%) of the 60 sides were found to have extradural C-4 contributions to the upper trunk of the brachial plexus. These sides were excluded from further study. No specimen was found to have a postfixed brachial plexus. Of the remaining 51 sides, 11 (21.6%) were found to have intradural neural connections between C-4 and C-5 dorsal rootlets and 1 (1.96%) had a connection between the ventral roots of C-4 and C-5. Communications between these 2 adjacent dorsal cervical cord levels were of 3 types. Type I was a vertical communication between the more horizontally traveling dorsal roots. Type II was a forked communication between adjacent C-4 and C-5 dorsal rootlets. The Type III designation was applied to connections between ventral rootlets. Although communications were slightly more frequent on left sides, this did not reach statistical significance.

Conclusions

In ~ 20% of normally composed brachial plexuses (those with extradural contributions from only C5–T1) we found intradural C4–5 neural connections. Such variations may lead to misinterpretation of spinal levels in pathological conditions of the spinal axis and should be considered in surgical procedures of this region, such as rhizotomy.

Ibn al-Nafis (1210–1288): The First Description of the Pulmonary Circulation

Ibn al-Nafis (1210–1288) was an Arab physician who contributed much to the advancement of medical knowledge and science in the 13th century. He was involved in jurisprudence, politics, and anatomical studies as well. Although a prominent ophthalmologist by training, today he is most recognized for his discovery of the lesser or pulmonary circulation. His was the first work to contradict the accepted teachings of Galen, which had existed since the 2nd century AD. His description included the observation that the wall of the septum is not porous either grossly or macroscopically as was believed by earlier scholars. Therefore, blood from the venous circulation had to be directed through the pulmonary artery (“venous artery”) through the lungs to be “mixed with air” and drained back to the left side of the heart through the pulmonary vein (“arterial vein”). This discovery would lead to a change in the historical observations that the pulmonary circulation was discovered by European scientists in the 16th century and lead many to wonder if these scientists had access to Ibn al-Nafis’ translated works. Ibn al-Nafis was devout to his work and to his religion, contributing much to the body of knowledge in anatomy and medicine as well as being a prominent and exceptional physician.

Ibn al-Nafis (1210-1288): the first description of the pulmonary circulation

Ibn al-Nafis (1210-1288) was an Arab physician who contributed much to the advancement of medical knowledge and science in the 13th century. He was involved in jurisprudence, politics, and anatomical studies as well. Although a prominent ophthalmologist by training, today he is most recognized for his discovery of the lesser or pulmonary circulation. His was the first work to contradict the accepted teachings of Galen, which had existed since the 2nd century AD. His description included the observation that the wall of the septum is not porous either grossly or macroscopically as was believed by earlier scholars. Therefore, blood from the venous circulation had to be directed through the pulmonary artery ("venous artery") through the lungs to be "mixed with air" and drained back to the left side of the heart through the pulmonary vein ("arterial vein"). This discovery would lead to a change in the historical observations that the pulmonary circulation was discovered by European scientists in the 16th century and lead many to wonder if these scientists had access to Ibn al-Nafis' translated works. Ibn al-Nafis was devout to his work and to his religion, contributing much to the body of knowledge in anatomy and medicine as well as being a prominent and exceptional physician.

The intriguing history of the human calvaria: sinister and religious

INTRODUCTION

A review of the ancient world finds multiple documentations describing the use of the human calvaria as a drinking implement.

TERMINOLOGY

This term, which is frequently and incorrectly called the "calvarium," has a unique history among multiple cultures of the world. For example, the purported site of Jesus' crucifixion "Calvary" is derived from this term calvaria. The present report explores the derivation, misuse, and history of the human calvaria.

Effects of the adducted or abducted position of the arm on the course of the musculocutaneous nerve during anterior approaches to the shoulder

Nerve injury is a common complication during anterior shoulder surgery. The purpose of the study was to evaluate the musculocutaneous nerve (MN) anatomically and to clarify the relationship of the MN to the glenoid labrum and coracoid process in different arm positions. The study was carried out on 40 shoulders of 20 adult cadavers fixed in 10% formaldehyde. The minimum distance of the MN at the entrance point of the nerve into the coracobrachialis to the anteromedial aspect of the coracoid tip and the distance between the MN and the top, middle, and inferior points of the glenoid labrum were measured. All measurements were performed with a digital caliper while the arm was in a neutral position, 45 degrees and 90 degrees of abduction, 90 degrees of abduction-internal rotation and 90 degrees of abduction-external rotation to evaluate whether arm position effects the results statistically or not. The results demonstrated that the position of the arm significantly changes the distance between the coracoid process (CP) and the MN or its cord. The change in distance between the glenoid labrum and the MN or its cord was also statistically significant. The distance between the CP and MN was greatest when the arm was abducted to 45 degrees (mean 3.4 cm) and least when the arm was positioned to 90 degrees of abduction-internal rotation (mean 2.0 cm). While the distance between the MN and the coracoid process was least at 90 degrees of abduction and internal rotation, the distance between the MN and glenoid labrum was lest with 90 degrees of abduction and external rotation. The distance between the glenoid labrum and MN was greatest with 45 degrees of abduction. The results of this study might be of use in avoiding the MN especially during Bristlow operations and certain rotator cuff procedures. Transferring the coracoid process during Bristow operations or placing arthroscopic portals when the arm is abducted to 45 degrees appears to be the safest position in terms of MN injury. Based on our results, when the arm needs to be abducted to 90 degrees during operation, externally rotating it may decrease the tension on the brachial plexus thus increasing the distance between the MN and the portals or retractors.

An anatomic investigation of the serratus posterior superior and serratus posterior inferior muscles

In classical anatomy textbooks the serratus posterior superior muscle was said to elevate the superior four ribs, thus increasing the AP diameter of the thorax and raising the sternum. However, electromyographic and other studies do not support its role in respiration. In order to help resolve this controversy and provide some insight into their possible functionality, the present study aimed at examining the morphology, topography and morphometry of serratus posterior superior and inferior muscles in both normal specimens and those derived from patients with a history of chronic obstructive pulmonary disorder (COPD). These muscles were examined in 50 human cadavers with an age range of 58-82 years. In 18 of the cadavers their histories revealed that they were suffering from COPD. There was no significant difference between right and left sides, race, gender and age and positive COPD history in regard to dimensions and nerves supply of serratus posterior superior and inferior muscles (P > 0.05). Based upon our findings that no morphometric differences exist between the of serratus posterior superior and inferior muscles of COPD patients versus controls, we are suggesting that no respiratory function be attributed to either of the serratus posterior superior and inferior muscles.

The velum interpositum revisited and redefined

INTRODUCTION

Descriptions of the velum interpositum (VI) are typically brief and lacking detail in most neuroanatomical and neurosurgical texts. As this structure may be involved clinically or encountered surgically, the present study seemed warranted.

MATERIALS AND METHODS

Twenty-adult (10 male and 10 female) formalin fixed and fresh cadaveric brains underwent a detailed dissection of the VI via an interhemispheric transcollosal approach. Observations were made of the attachment sites and continuation of the VI. Measurements were made of its length and width at its anterior, midportion, and posterior parts.

RESULTS

The VI extended laterally over the thalami to become continuous with the choroid plexus of the lateral ventricles. At a point along the thalami where the choroid plexus was found, the VI became "tacked" down and thus continuous with the choroid plexus subependymally. No specimen exhibited a separate choroid plexus of the third ventricle. In each, the choroid plexus of the lateral and third ventricles were the same tissue layer, all arising from the VI. This structure was adherent to but not fused to the deep surface of the fornix. The VI was also not fused to the pineal gland or habenula commissure but simply covered these structures. This membrane was confluent with the pia/arachnoid over the cerebellum and from the inferior surface of the parietal/occipital lobes and extended laterally into the choroid fissure.

CONCLUSIONS

To our knowledge, the extent of the VI as described herein has not been reported earlier. The supratentorial choroid plexus is simply a vascular extension of the VI. There is no separate choroid plexus of the third ventricle as often described. Clear planes exist between the VI and surrounding structures such as the pineal gland. Such data may be useful to neurosurgeons who operate in this region and to clinicians who interpret imaging in the area of the VI.

Popliteal artery aneurysms: a review

Popliteal artery aneurysms (PAAs) are the most common form of peripheral arterial aneurysms. The popliteal artery is the continuation of the femoral artery and represents the major source of blood to the leg. Thrombus formation as a result of PAA may reduce blood flow, leading to limb-threatening ischemia and potential limb amputation. Popliteal artery aneurysms are predominantly seen in males (95-99% of cases), presumably owing to their predisposition for arteriosclerosis, which is also a major factor for PAA predisposition. Additionally, it is not uncommon to see an abdominal aortic aneurysm associated with a PAA (30-50% of cases) or bilateral presentation of PAA (approximately 50% of cases). A consequence of a PAA and thrombus located in the popliteal fossa is an inflammatory reaction, potentially involving adjacent structures in the fossa. This may present clinically as pain in the leg and/or edema. Treatment of PAA involves either a conservative management protocol or a more aggressive intervention such as surgery. Proponents of conservative management will regulate the diameter of the aneurysm by ultrasound, while those in favor of surgical intervention will repair the aneurysm through a number of open surgical methods or by endovascular stent grafting. This review summarizes the historical points related to PAA and analyzes the pertinent anatomical implications, clinical findings and treatment methods for PAA.

Anatomy and potential clinical significance of the vastoadductor membrane

Few reports are found in the extant medical literature regarding the vastoadductor membrane. This membrane effectively creates a subcompartment within the subsartorial canal. The lower limbs of 16 embalmed adult cadavers were dissected to identify the vastoadductor membrane and note its measurements. A vastoadductor membrane was identified in all specimens and was derived from the medial intermuscular septum. This membrane connected the medial edge of the vastus medialis muscle to the lateral edge of the adductor magnus muscle. Membranes were all wider proximally and narrowed distally. The mean length of this structure was 7.6 cm. The mean width of the vastoadductor membrane at its proximal, midportion, and distal parts was 2.2, 1.7, and 0.5 cm, respectively. The mean distance from the anterior superior iliac spine to the proximal border of the vastoadductor membrane was 28 cm. The mean distance from the distal border of the membrane to the adductor tubercle was 10 cm. Seventy-five percent of specimens exhibited a fenestrated vastoadductor membrane. Branches of the saphenous nerve to the skin of the medial thigh pierced the vastoadductor membrane in 31% of specimens. Two specimens demonstrated branches derived from the branch of the obturator nerve that pierced this membrane en route to the skin of the medial thigh. Perforating venous branches from the great saphenous vein were identified in 22% of specimens. As compression of the femoral artery at the adductor hiatus is a well-recognized entity, the clinician may also try to explore potential compression of this vessel more proximally by an overlying vastoadductor membrane. The authors would also hypothesize that due to the interconnection between the adductor magnus and vastus medialis by the vastoadductor membrane that a potential synergy exists between the functions of these two muscles.

Surgical anatomy of the external branch of the superior laryngeal nerve

Palsy of the external branch of the superior laryngeal nerve (EBSLN) during thyroid surgery is an important complication reported with varying frequency. This study was carried out to investigate the relationship between the EBSLN, the upper part of the thyroid gland and the inferior constrictor muscle of the pharynx (IC), and also to define consistent landmarks for identifying and preserving the EBSLN. Forty neck halves of 20 cadavers were dissected. Measurements were obtained between the crossing point of the EBSLN with the superior thyroid artery (STA) and the upper pole of the thyroid gland, the point where EBSLN penetrates the IC and the inferior thyroid tubercle, and the middle point of the oblique line of the thyroid cartilage, and the EBSLN. In 22.5%, the EBSLN crossed the STA more than 1 cm above the upper pole of the thyroid gland (Type I of Cernea et al. [1992a] Head Neck 14:380-383). In 60%, the EBSLN crossed the STA less than 1 cm above the upper pole of the thyroid gland (Type IIa of Cernea et al. [1992a] Head Neck 14:380-383). In 17.5%, the EBSLN crossed the STA under the upper pole of the thyroid gland (Type IIb of Cernea et al. [1992a], Head Neck 14:380-383). In 22.5%, the full course of the nerve was superficial to the IC (Type 1 of Friedman et al. [2002] Arch Otolaryngol Head Neck Surg 128:296-303). In 67.5%, the nerve penetrated the IC (Type 2 of Friedman et al. [2002] Arch Otolaryngol Head Neck Surg 128:296-303). In 10%, the nerve could not be identified at the lateral side of the IC (Type 3 of Friedman et al. [2002] Arch Otolaryngol Head Neck Surg 128:296-303). In conclusion, it is possible to identify the nerve superficial to the IC in 90% of specimens on average. Knowledge of the relationship between the EBSLN, IC, inferior thyroid tubercle, oblique line of the thyroid cartilage and the sternothyroid muscle will be useful for the surgeon in avoiding unexpected complications.

The anatomic branch pattern of the axillary nerve

The purpose of this study is to determine the surgical anatomy and innervation pattern of the branches of the axillary nerve and discuss the clinical importance of the presented findings. We dissected 30 shoulders in 15 fixed adult cadavers under a microscope through anterior and posterior approaches. The axillary nerve was examined in 2 segments in relation to the underlying subscapularis muscle. The axillary nerve gave off no branches in the first segment in 85% of cases. When the posterior approach was used, the axillary nerve and its branches were observed to be in a triangular-shaped area. The mean distance from the posterolateral corner of the acromion to the axillary nerve and its branches was 7.8 cm. In all cases, the posterior branch of the axillary nerve gave off its first muscular branch to innervate the teres minor. The joint branch of the axillary nerve was observed to branch out in 3 different patterns. The acromial and clavicular parts of the deltoid muscle were observed to be innervated from the anterior branch of the axillary nerve in all cases. The posterior part of the deltoid muscle was observed to be innervated in 3 different patterns. The posterior part of the deltoid was innervated from the branch or branches coming only from the posterior branch in 70% of cases, from the anterior and posterior branches in 26.7% of cases, and from the anterior branch in 3.3% of cases. The findings of this study are useful for identifying each of the branches of the axillary nerve and have implications for surgeries related with selective innervation.

The anatomic relationships of the axillary nerve and surgical landmarks for its localization from the anterior aspect of the shoulder

The axillary nerve has long been known to be one of the nerves vulnerable to damage during shoulder arthroscopic and open surgical procedures. The relationship of the axillary nerve to the shoulder capsule and the subscapularis muscle has not been well defined in orthopedic literature. This descriptive anatomical study aimed to present the course and the relations of the axillary nerve with neighboring neurovascular structures and the shoulder capsule and to define anatomical landmarks and regions that can be used practically in anterior surgical approaches to the shoulder region. To investigate the course of the axillary nerve and its relationship with neighboring structures, 30 shoulders of 15 fixed adult cadavers were dissected under the microscope through an anterior approach. A triangle-shaped anatomic area containing the axillary neurovascular bundle was defined. The closest distance between the axillary nerve and the anteromedial aspect of the coracoid tip and the glenoid labrum was measured as 3.7 cm and 1.1 cm on average, respectively. The distance between the anteromedial aspect of the coracoid tip and the point where the nerve passes through the medial edge of the subscapularis was measured as 2.5 cm on average. The results of this study demonstrate the anatomic pattern and the course of the axillary nerve and its relations with the shoulder capsule. Knowing the exact localization of the axillary nerve under the guidance of the defined anatomic triangle may provide a safer surgery.