Persistent sciatic vessels associated with an arteriovenous malformation

The sciatic artery is the major arterial supply to the lower limb bud at an early embryological stage. It primarily originates from the dorsal root of the umbilical artery. After the 22 mm embryological stage, the sciatic artery involutes and the femoral artery system develops as the major inflow source to the lower limb. In the adult, remnants of the sciatic artery persist as the proximal portion of the inferior gluteal artery, the popliteal and peroneal arteries (Williams et al. 1989). It is suggested that either failure in development of the femoral system or failure in regression of the sciatic artery results in persistence of this artery (Arey, 1965). We report a rare example of persistent sciatic artery (PSA) accompanied by arterio-arterial and arteriovenous anastomoses

Anatomy of master knot of henry: A morphometric study on cadavers

WOS: 000433350100010PubMed ID: 29366540Objective: The objective of this study was to evaluate the features of flexor hallucis longus (FHL), flexor digitorum longus (FDL) and flexor digitorum accessorius (FDA) muscles with relevance to the tendon grafts and to reveal the location of Master Knot of Henry (MKH). Methods: Twenty feet from ten formalin fixed cadavers were dissected, which were in the inventory of Anatomy Department of Medicine Faculty, Mersin University. The location of MKH was identified. Interconnections of FHL and FDL were categorized. According to incision techniques, lengths of FHL and FDL tendon grafts were measured. Attachment sites of FDA were assessed. Results: MKH was 12.61 +/- 1.11 cm proximal to first interphalangeal joint, 1.75 +/- 0.39 cm below to navicular tuberosity and 5.93 +/- 0.74cm distal to medial malleolus. The connections of FHL and FDL were classified in 7 types. Tendon graft lengths of FDL according to medial and plantar approaches were 6.14 +/- 0.60cm and 9.37 +/- 0.77cm, respectively. Tendon graft lengths of FHL according to single, double and minimal invasive incision techniques were 5.75 +/- 0.63cm, 7.03 +/- 0.86cm and 20.22 +/- 1.32 cm, respectively. FDA was found to be inserting to FHL slips in all cases and it inserted to various surfaces of FDL. Conclusion: The exact location of MKH and slips was determined. Two new connections not recorded in literature were found. It was observed that the main attachment site of FDA was the FHL slips. The surgical awareness of connections between the FHL, FDL and FDA, which participated in the formation of long flexor tendons of toes, could be important for reducing possible loss of function after tendon transfers postoperatively

Morphological features of the chiasma tendinum and its relation with surface landmarks and pulleys: a cadaveric study

Aim!#!Chiasma tendinum (Camper's chiasm) is of great importance in the delicate movements and stability of the fingers and takes place poorly in the literature. This study aims to reveal the morphometric details of the chiasma tendinum in relation with pulleys and other relevant structures.!##!Materials and methods!#!Palm and 2nd to 5th fingers of 10 (6 male, 4 female) formalin fixed cadavers were used bilaterally. After determining the superficial reference points on the fingers, the skin and the tendon sheath were incised, and then measurements of chiasma tendinum and related tendons were performed. The measurements were analyzed with respect to fingers, genders, and sides. Finally, the types of chiasma tendinum were identified and then grouped as symmetrical, asymmetrical, and pseudo chiasm.!##!Results!#!Pulley and chiasma tendinum positions were correlated with finger length (p < 0.01). Pulley lengths were significantly less in females. Asymmetrical chiasma tendinum types were found in 45% of the fingers. In most comparisons, values for fifth finger were significantly different than that of other fingers and chiasma tendinum types differed according to fingers and gender. The case of no fiber exchange was observed only in the 5th finger in 15%.!##!Conclusion!#!Findings related to the prediction of location of the pulleys and chiasma tendinum according to the superficial signs, awareness of cases where one of the two arms of the flexor digitorum superficialis is extremely thin and no fiber exchanges that may be risk factors for spontaneous tendon rupture may help provide more accurate approaches in relevant clinical applications

Thoracodorsal and Lateral Thoracic Arteries in Coronary Bypass Surgery as an Alternative Arterial Graft: A Morphological Study

Amaç: A. thoracica interna ve v. saphena magna günümüzde en sık kullanılan koroner by-pass greftleridir. Arteryel greftler, venöz greftlere göre daha iyi açık kalma oranlarına sahiptir. A. thoracica interna ve v. saphena magna'nın kullanılamayacağı veya daha önceki operasyonda kullanıldığı, ayrıca birden fazla koroner artere aynı anda by-pass gerektiren veya birden fazla grefte ihtiyaç duyulan durumlarda halen alternatif arteryel greftlere ihtiyaç vardır. Gereç ve Yöntem: Bu çalısmada, yas ortalaması 56,676,38 olan 9 erkek kadavradan bilateral olarak elde edilen, a. thoracica lateralis ve a. thoracodorsalis'in koroner by-pass operasyonlarında greft olarak kullanıma uygun olup olmadıklarının ortaya konulması amaçlandı. Bu arterlerin bas, orta ve son kısımlarına ait morfolojik özellikler (boy, lümen çapı, tunica intima ve media kalınlıkları, lamina elastica interna ve externa'nın özellikleri, tunica media tabakasının elastik ve düz kas dokusu içeriği) a. thoracica interna, a. radialis ve koroner arterlerin (r. interventricularis anterior, r. circumflexus, a. coronaria dextra) morfolojik özellikleriyle karsılastırıldı. Bulgular: A. thoracica lateralis ve a. thoracodorsalis'in iyi gelismis lamina elastica interna'ya sahip oldukları saptandı. Ayrıca a. thoracica lateralis ve a. thoracodorsalis'nin tunica intima ve media kalınlıkları genellikle a. thoracica interna ve a. radialis'in tunica intima ve media kalınlıklarına benzer veya daha ince olduğu görüldü. Bu bulgular, her iki arterin koroner by-pass cerrahisinde greft olarak kullanılabilmesi açısından olumlu özellikler olarak değerlendirildi. Sonuç: A. thoracica lateralis'in boy ve lümen çapı, tek basına serbest greft olarak kullanım için yeterli bulunmazken, a. thoracodorsalis ise yeterli bulundu. Bununla birlikte her iki arterin, diğer greftlerle birlikte kompozit greft (Y greft gibi) uygulamalarında, boy ve lümen açısından yeterli olabileceği sonucuna varıldı.By-pass Cerrahisi. 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

Radiological hip indices correlate with GMFCS level I and GMFM-66 scores in cerebral pasy

Objectives: The aim of this study was to evaluate the certain radiological hip parameters and the effects of these parameters on the functional capacity of cerebral palsy (CP) children, to compare the Gross Motor Function Measure (GMFM-66 scores) of hemiparetic and diparetic children with spastic CP in Gross Motor Function Classification System (GMFCS) level 1, and to define possible differences or similarities with the control group. Methods: The radiographic parameters measured for CP and control groups were caput-collum-diaphyseal angle (CCD), migration index (MI), center edge angle (CEA), acetabular index (AI) and pelvic obliquity. The functional capacity of the CP group was assessed by GMFM-66. Results: No significant differences were found in terms of sides of the same individual in each group. Significant differences were found between groups for left CCD, right MI, right and left AI, and right and left CEA. Correlation analyses revealed significant relationships between radiological parameters. Hemiparetics had statistically higher GMFM-66 dimension E score than diparetics. Conclusion: The threshold values for hip parameters were determined with CP in GMFCS level 1. The hemiparetic and diparetic children with CP, who were at the GMFCS level I and age group, had similar hip morphology. Development of femoral head and acetabulum in these children were not different from control group. Evaluating the functional levels of patients according to GMFM-66 scores with radiographic parameters is believed to contribute to the monitoring CP children

Intravenous organophosphate injection: An unusual way of intoxication

Organophosphate insecticides strongly inhibit both true cholinesterase and pseudocholinesterase activities. In this report, we have reported a patient who injected himself a strong organophosphate compound, methamidophos, and showed the typical clinical picture of organophosphate intoxication. As far as we know, this is the first case of intoxication by intravenous (i.v.) injection. With the appropriate therapy, his symptoms disappeared in a few days

Evaluation of Epidemiological, Clinical and Laboratory Characteristics of Patients with Spondylodiscitis

Introduction: Spondylodiscitis is an infection of the intervertebral disc and the adjacent vertebrae and is hematogenous in origin in most cases. The aim of this study was to evaluate the epidemiological, clinical and laboratory characteristics of patients with spondylodiscitis followed in the infectious diseases and clinical microbiology clinic. Materials and Methods: Findings of the patients were evaluated retrospectively. Diagnosis of spondylodiscitis was made based on clinical findings, microbiological and serological test results, radiological findings, and histopathological evaluation. Results: Among 22 patients included in the study, 16 were male (72.7%) and 6 were female (27.3%), and their mean age was 54 ± 16.3 years. The most common symptoms were backache, difficulty in walking, leg pain, and sweating (in 100%, 40.9%, 27.3%, and 22.7%, respectively). C-reactive protein (CRP) and sedimentation rate were found high in 63.6% and 77.3% of the patients, respectively. In 8 (36.4%) patients, brucella agglutination test was positive. All the blood cultures were negative. Biopsy culture was performed in seven patients, and Escherichia coli and Bacillus pumilus were isolated in one patient each. In one patient, acido-resistant bacilli (ARB) was found positive in biopsy material, but tuberculosis culture remained negative. Magnetic resonance imaging findings were compatible with spondylodiscitis in all patients, and in two patients, findings appeared to be tuberculosis. Twelve patients (54.5%) were diagnosed as pyogenic spondylodiscitis, 8 (36.4%) as brucellar spondylodiscitis and 2 (9.1%) as tuberculous spondylodiscitis. Conclusion: Spondylodiscitis must be kept in mind in patients with vertebral pain and high CRP and sedimentation rate even in the absence of fever. Most of our patients were pyogenic spondylodiscitis, but brucellar and tuberculous spondylodiscitis patients were diagnosed as well. We suggest that tuberculosis and brucellosis should be remembered among the causes of spondylodiscitis, especially in endemic regions