Re-evaluation of the symptoms of Hirayama disease through anatomical perspective

Hirayama disease is a rare disease of the anterior horn motor neuron caused by compression of the cervical spinal cord when the neck is flexed. Cervical myelopathy may accompany the disease. It is characterized by symmetrical or asymmetrical muscle weakness and atrophy of muscles innervated by lower cervical and upper thoracic motor neurons. We recorded two male cases of Hirayama disease between the ages of 15 and 21 based on magnetic resonance imaging (MRI) features obtained from the cervical neutral state and from the flexion position which appeared in the right upper extremity. Loss of strength and atrophy in the right upper extremities was existent in clinical findings of these patients. When MRI was taken in the flexion position, there were dilated veins as hypointense signal void on T2 weighted series in posterior epidural area. The contrast enhancement was seen on these veins. It was observed that the posterior dura was displaced anteriorly and the anterior subarachnoid space was narrow. In cases which show clinical findings such as atrophy and loss of strength, having normal MRI results obtained in the neutral position makes it difficult to diagnose Hirayama Disease. In case of a suspicion of Hirayama disease the diagnosis can be made more easily by MRI taken in the flexion position. These case reports aim to bring Hirayama disease to mind and optimize the management of affected individuals

Cadaveric investigation of the spread of the thoracoabdominal nerve block using the perichondral and modified perichondral approaches

Interfascial plane blocks and associated nomenclature are currently popular topics in the field of anesthesia. While several novel plane blocks have been described, cadaveric studies on the spread of novel blocks are important for determining appropriate applications [1]. Recently, Tulgar et al. [2] defined the thoracoabdominal nerve block using a perichondral approach (TAPA). They reported that local anesthetic (LA) administered on the upper and lower aspect of the 9th through the 10th costal cartilages would block both the anterior and lateral cutaneous branches, thus providing abdominal analgesia. After describing the TAPA, the authors also redefined the approach, naming it the modified TAPA (M-TAPA). They reported that administering LA only to the lower surface of the costal cartilage would provide successful analgesia similar to that provided by the TAPA [3]. In the literature, there are some case reports and observational studies on the TAPA and M-TAPA [2,3]; however, to the best of our knowledge, no reliable cadaveric investigation has demonstrated the spread of these blocks. Therefore, in this cadaveric investigation, we aimed to evaluate the areas of spread associated with the TAPA and M-TAPA. This study was approved by the Istanbul Medipol University Ethics and Research Committee (Decision No. 36, 06.01.2022)

Evaluation of the volume of amygdaloid body,hippocampus, insula and temporal lobe in alzheimer'sdisease and other types of dementias

Demans ve Alzheimer hastalığı ortalama yaşam ömrünün uzamasıyla yaşlı popülasyonda sıklıkla görülen, nedenleri tam anlaşılamamış ve tedavisi bulunmayan progresif nörodejeneratif hastalıklardır. Bu çalışmada, demans ve Alzheimer'da özellikle tutulan beyin bölgelerini tespit etmek için hippocampus alt bölgelerindeki atrofi paterni ve bazı limbik yapıların atrofi düzeyinin belirlenmesi amaçlanmıştır. Bu amaçla, 61 birey, Alzheimer hastası (18), demans (16) ve sağlıklı kontrol (27) olmak üzere 3 gruba ayrılarak T1 ağırlıklı görüntülerinde MRICloud ve VolBrain ile hacimsel değerlendirilmeleri yapıldı. Gyrus temporalis medius, total hippocampus, sağ ve sol CA1, sol CA2-3 ve CA4-DG hacimleri kontrol grubunda Alzheimer grubundan anlamlı olarak fazla bulundu (p0,05). Sağ rostral ve dorsal anterior gyrus cinguli beyaz cevher hacimleri, demansta Alzheimer grubundan; subgenual anterior gyrus cinguli sol beyaz cevher ve sağ gri cevher hacimleri kontrol grubunda Alzheimer grubundan anlamlı oranda fazla bulundu (p0,05). Sonuç olarak; demans ve Alzheimer hastalıklarında hippocampus segmentleri ve anterior gyrus cinguli'nin alt bölüm hacimlerinin değerlendirilmesinin, hastalıkların evreleri ve bu bölgelerin hastalıklarla olan fonksiyonel ilişkilerinin belirlenmesinde yardımcı olacağı sonucuna varılmıştır.Dementia and Alzheimer's disease are progressive neurodegenerative diseases that are frequently seen in the elderly population, their reasons are not fully understood and have no cure. In this study, it was aimed to determine the atrophy pattern of hippocampal sub-regions and some limbic structures in order to detect the brain regions especially affected in these diseases. For this purpose, 61 individuals were divided into 3 groups as Alzheimer (18), dementia (16), healthy control (27) and volumetric evaluation was made with MRICloud and VolBrain on T1-weighted MRIs. In control group, volumes of middle temporal gyrus, total hippocampus, right and left CA1, left CA2-3 and CA4-DG segments were significantly higher than Alzheimer's group (p 0.05). In dementia group, white matter volumes of right rostral and dorsal anterior cingulate gyrus were significantly higher than Alzheimer's group; in control group, left white and the right gray matter volumes of subgenual anterior cingulate gyrus were higher than Alzheimer's group (p 0.05). It has been concluded that evaluating the hippocampal segments and volumes of subdivision of anterior cingulate gyrus in dementia and Alzheimer's disease will help determine the stages of the diseases and the functional relations between these regions and diseases

Para-sartorial compartments block: A cadaveric study of dye spreading

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Recto-intercostal fascial plane block: Another novel fascial plane block

Superficial and deep parasternal intercostal plane blocks are preferable options as fascial plane blocks in parasternal region surgeries. These techniques aim to block the anterior cutaneous branches of T2-T6 thoracic nerves. However, with these blocks, it is impossible to block the T7 and lower anterior cutaneous branches and the lateral cutaneous branches of the thoracoabdominal nerves [1]. In cardiac surgeries with median sternotomy, mediastinal tube placement sites are outside the parasternal block effect area, and sometimes the sternotomy incision extends below the T6 dermatome. Generally, surgeons apply LA infiltration to tube entry points for analgesia. In cases where sternum revision is required -if awake surgery is preferred- parasternal blocks alone are not sufficient, clinicians seek complementary techniques (such as pectoralis-intercostal rectus sheath (PIRS) plane block)