Suitability of foramen magnum measurements in sex determination and their clinical significance

Background: The foramen magnum provides a transition between fossa cranii posterior and canalis vertebralis. Medulla oblongata, arteria vertebralis and nervus accessorius spinal part pass through the foramen magnum. In this study, we aimed to make the morphometric measurements of the foramen magnum on computed tomography (CT) and to determine the feasibility of sex determination based on these measurements. Besides sex determination, from a clinical aspect, it is important to know the measurements of the foramen magnum in the normal population in terms of diseases characterised by displacement of the posterior fossa structures through foramen magnum to upper cervical spinal canal such as Chiari malformations and syringomyelia. Materials and methods: All the data for our study was obtained retrospectively from 100 patients (50 males, 50 females) who had a CT scan of the head and neck region in Adnan Menderes University Hospital, Department of Radiology. To examine the foramen magnum in each and every occipital bone, we measured the foramen magnum’s anteroposterior diameter, transverse diameter, the area of the foramen magnum and its circumference. Results: We found that men have a higher average value than women in our study. According to Student’s t-test results; in all measured parameters, there is significant difference between the genders (p < 0.05). When multivariate discriminant function test is performed for all four measurements, the discrimination rate is 64% for all women, 70% for all men and 67% for both genders. Conclusions: As a result of our study, the metric data we obtained will be useful in cases where the skeletons’ sex could not be determined by any other methods. We believe that, our study may be useful for other studies in determining of sex from foramen magnum. Our measurements could give some information of the normal ranges of the foramen magnum in normal population, so that this can contribute to the diagnosis process of some diseases by imaging. (Folia Morphol 2018; 77, 1: 99–104)  

Frontalis sling operation with deep temporal fascial graft in blepharoptosis repair

WOS: 000173102600038PubMed: 11786820

Prefabrication of a free peripheral nerve graft following implantation on an arteriovenous pedicle

WOS: 000175839800005PubMed: 12022033Extensive nerve injuries frequently necessitate the use of long autografts, and sources of expendable donor nerves are limited. It is for these cases that nerve transplantation would have its greatest potential. However, regeneration in the rejected allograft fails because of a lack of the positive neurotropic and neurotrophic influences physiologically, provided by, viable Schwann cells. This report aims to show the feasibility, of vascularization of the peripheral nerve by, prefabrication. The study, was designed to vascularize an autogenous nerve graft segment by, using an arteriovenous bundle in the rabbit. A 3.5-cm segment of sciatic nerve was harvested and implanted in between the femoral vessels, and was isolated from secondary, revascularization by, a custom-made tube. A peripheral nerve graft was prefabricated by implantation on the vascular pedicle, and neovascularization was evaluated by, microangiography and histology,. The graft exhibited early neovascularization on day 2, and numerous new capillaries were noted to restore primarily perineurial blood flow on day 7, then all along the graft on day, 14. The viability, of the Schwann cells was preserved, and the structural integrity of the graft was maintained. This is a preliminary, report on secondary, vascularization of a segment of an autogenous nerve to maintain the viability of Schwann cells and the integrity of the conduit. In the future, with the concomitant use of host immunosuppression or with more advanced pre-treatment methods, nerve allografts could be revascularized by vascular bundles. The current tempo of medical research will hopefully enable the use of fresh nerve allografts that are rendered less immunogenic by, more refined techniques

Understanding Complex Coordination Processes in Health Care

This paper identifies and analyses complex coordination processes at radiolog

Subcutaneous emphysema of the hand caused by the suction drain - A case report

PubMed: 15368154Subcutaneous emphysema of the hand can be related to non-infectious causes and most commonly high-pressure injection injuries. Surgical emphysema of the hand is rare. We report a case of surgical emphysema of the dorsum of the hand following the excision of a dorsal wrist ganglion when the inserted suction drain did not work properly, accompanied by the inadvertent compression of the patient's body. Conservative management was adequate; oedema and emphysema subsided in several days

Reconstruction of proximal nasal defects with island composite nasal flaps

WOS: 000226817300007PubMed: 15692344There are few local nasal flap options for repair of proximal nasal defects. Absence of suitable donor sites and the large dimensions of the defects limit the use of local nasal flaps in this region. Regional paranasal flaps may not be suitable in these cases because of color, texture, and donor-site scars. The composite procerus muscle and nasal skin flap, which is vascularized by the dorsal nasal branch of the angular artery, can be a useful treatment modality for proximal nasal reconstruction. Seven patients were successfully treated using the composite nasal flaps. The maximal size of the defects was 2.4 cm. In one case, the composite nasal flap was readvanced to close a new defect resulting from reexcision. The composite nasal flap has several advantages in reconstruction of proximal nasal defects. Reconstruction is performed with the same tissue and the donor defect is closed primarily. The composite nasal flap can be moved in multiple directions and has great mobility to reach every point of the proximal part of the nose with axial blood supply. Furthermore, it can be easily readvanced without additional morbidity in case of reexcision

Efficacy and safety of high dose intramuscular or oral cholecalciferol in vitamin D deficient/insufficient elderly

PubMedID: 22613271Objectives: To evaluate and compare the effects and safety of high dose intramuscular (IM) or oral cholecalciferol on 25-hydroxyvitamin D [25(OH)D] levels, muscle strength and physical performance in vitamin D deficient/insufficient elderly. Study design: Randomized prospective study. Main outcome measures: 116 ambulatory individuals aged 65 years or older living in a nursing home were evaluated. Eligible patients with 25(OH)D levels <30 ng/ml (n = 66) were randomized to IM or Oral groups according to the administration route of 600,000 IU cholecalciferol. Demographic and descriptive data were collected. Biochemical response was measured at baseline, 6th and 12th weeks. Muscle strength was measured from quadriceps by using a hand-held dynamometer and physical performance was evaluated by short physical performance battery (SPPB) at the beginning and 12th week. Results: Among the screened ambulatory elderly only 5.2% (n = 6) had adequate vitamin D levels. 37.1% (n = 43) were vitamin D deficient and 57.7% (n = 67) were insufficient. After administration of one megadose of vitamin D, mean serum 25(OH)D levels increased significantly at 6th week (32.72 ± 9.0 ng/ml) and at 12th week (52.34 ± 14.2 ng/ml) compared with baseline (11.76 ± 7.6 ng/ml) in IM group (p < 0.0001). In Oral group levels were 47.57 ± 12.7 ng/ml, 42.94 ± 13.4 ng/ml and 14.87 ± 6.9 ng/ml, respectively (p < 0.0001). At 12th week the increase in IM group was significantly higher than Oral group (p = 0.003). At the end of the study period, serum 25(OH)D levels were ?30 ng/ml in all patients in IM group and in 83.3% of the patients in the Oral group. Quadriceps muscle strength and SPPB total score increased significantly in both groups and SPPB balance subscale score increased only in IM group. Six patients (9.6%) developed hypercalciuria, no significant adverse events were observed. Conclusion: In vitamin D deficient/insufficient elderly, a single megadose of cholecalciferol increased vitamin D levels significantly and the majority of the patients reached optimal levels. Although both administration routes are effective and appear to be safe, IM application is more effective in increasing 25(OH)D levels and balance performance. © 2012 Elsevier Ireland Ltd. All rights reserved.The study was supported by the Research Fund of the Cukurova University. Project No. TF2009 LTP39

Diclofenac and metamizol in postoperative analgesia in plastic surgery

PubMed: 11692987Background: Postoperative pain relief after major surgery cannot be achieved with opioids alone in all patients without respiratory depression or other significant drawbacks. Modern medical practice, therefore, dictates the use of alternative analgesic agents as an adjunct or substitute to minimize the deleterious effects and to facilitate an earlier return to work and daily activities. Diclofenac and metamizol inhibit prostaglandin synthesis, thus attenuate the peripheral nociceptive sensitization caused by the surgical trauma. This investigation was conducted to determine the potency of diclofenac compared with metamizol in the control of postoperative pain after various plastic surgical operations under general anesthesia. Methods: A multiple-dose, randomized, double-blind clinical trial composed of one hundred and sixty-six patients was conducted. Group M patients received 1 g intramuscular metamizol (every 8 hours) and Group D patients received 75 mg intramuscular diclofenac (every 12 hours). Additional analgesia requirements were recorded and meperidine was used as the complementary analgesic when needed. Plain was assessed by visual analogue scores. Platelet count and bleeding time analyses were performed preoperatively and on the first postoperative day. Results: Metamizol decreased the additional analgesia requirement during the 18 hours following surgery. This was also associated with significantly lower pain scores. There was no significant difference between the patients receiving either metamizol or diclofenac in terms of pain scores, additional request for analgesia and frequency of side effects from the 18th until the 48th hour postoperatively. However, the use of diclofenac was associated with reduced side effects, though a reduction in platelet number and prolongation of bleeding time was noted in the majority of the patients receiving diclofenac. Conclusions: Metamizol is significantly superior to diclofenac for the reduction of postoperative pain after plastic surgery in the first 18 hours after plastic surgery procedures and reduces the need for additional analgesia