Innervation of the coracobrachialis muscle by a branch from the lateral root of the median nerve

Anomalies of the brachial plexus have previously been described in the literature. The coracobrachialis muscle is typically innervated by the musculocutaneous nerve. During a gross anatomy dissection we found that the coracobrachialis muscle was innervated by a branch from the lateral root of the median nerve. Knowledge of the anatomical variations of the peripheral nervous system is important in interpreting unusual clinical presentations. This report will assist clinicians and surgeons by pointing out anatomical anomalies associated with the musculocutaneous nerve, the median nerve and their branches to the anterior compartment muscles of the upper arm

Ultrastructural Analysis of Urinary Stones by Microfocus Computed Tomography and Comparison with Chemical Analysis

Objective: To investigate the ultra-structure of urinary system stones using micro-focus computed tomography (MCT), which makes non-destructive analysis and to compare with wet chemical analysis. Methods: This study was carried out at the Ankara Train­ing and Research hospital. Renal stones, removed from 30 patients during percutaneous nephrolithotomy (PNL) surgery, were included in the study. The stones were blindly evaluated by the specialists with MCT and chemi­cal analysis. Results: The comparison of the stone components be­tween chemical analysis and MCT, showed that the rate of consistence was very low (p0.05). It was also seen that there was no significant relation between its 3D structure being heterogeneous or homogenous. Conclusion: The stone analysis with MCT is a time con­suming and costly method. This method is useful to un­derstand the mechanisms of stone formation and an im­portant guide to develop the future treatment modalities

Lipopolisakkaritle Oluşturulan Nöroinflamasyon Modelinde Pro-İnflamatuar Sitokinlerin ve Yolaklarının Glia Limitans Üzerine Etkileri

The term Neuroinflammation (NI) that is unique for Central Nervous System (CNS), defines a process that includes complex cellular and intercellular relationships. The inflammatory responses of microglia and astrocytes formed after damage or intensive stimulus might fortify the effects of acute injury or contribute to activation of neurodegenerative mechanisms. Microglia and astrocytes activated by NI increase the expression of many potential neurotoxic chemo-attractant molecules and cytokines. Glia limitans (GL) is the outermost layer of cortex and is formed by astrocytic end feet and basal membrane surrounding vascular structures, thereby functioning like modified blood-brain barrier for the regulation of the movement of small molecules and cells to the brain parenchyma. Although the relationship between neural tissue and its adventia layer was investigated in other tissues, the similar interaction between the brain parenchyma and its adventia layer, which is composed of GL and meninges, is not studied. In this study, we investigated the expression of pro-inflammatory cytokines (Interleukin 1 beta - IL1β, Interleukin 6 - IL6, Tumor necrosis factor alfa - TNFα) and their receptors (tumor necrosis factor receptor 1, 2- TNFR1, TNFR2, interleukin1 receptor1- IL1R1) in both superficial and perivascular GL, in a mice model of neuroinflammation induced by bacterial lipopolysaccharide (LPS) in 2th and 4th hour. We used molecular (Western blotting) and imaging (immunohistochemistry, immuno-gold and transmission electron microscopy) techniques. Swelling on the astrocytic end feet as an indicator of NI and syncytial mitochondria supporting increased energy demand on the distal poles of these structures were seen with transmission electron microscopy (TEM) images in intracerebroventricular (ICV) LPS induced NI mice model. Vesicles filled with cytokines, which were ready to be secreted from activated astrocytes, were visualized by TEM and immune-gold TEM. IL1β were determined in GLs of surface associated astrocytes and descending parts, directed towards parenchyma, which mainly found in superficial cortical areas, fitting the astrocytic activity occurred at the same time period of immunocytochemistry findings. TNFα visualized as patchy, cytoplasmic and diffuse both in GLs and GLp. IL6, which has both inflammatory and neuroprotective features and maybe secreted later and less than other two cytokines, could not be visualized in a distinct pattern on GL. IL1R1 were detected in both GLs and GLp with the distribution resembling IL1β. Western blotting of GL of mice containing the superficial cortex showed a significant increase of IL6 and IL1β at the 4th hour of NI. These findings indicate that, inflammatory changes occur in astrocytes and GL at the hyper-acute period of ICV LPS induced NI and is thought that astrocytes are important for processes of neurodegenerative diseases.Nöroinflamasyon (Nİ) merkezi sinir sistemi (MSS)’ne özgü, herhangi bir hasara veya şiddetli uyarana maruziyet sonucu esas olarak mikroglia ve astrositlerin inflamasyon benzeri cevaplarıyla oluşan karmaşık hücresel ve hücreler arası ilişkileri içeren bir süreçtir. Nörodejeneratif (ND) hastalıklar, travmatik beyin hasarı, inme ve nöropatik ağrı gibi pek çok hastalığın etyopatogenezinde rol oynadığı düşünülmektedir. Nİ’de aktive olan mikroglialar ve astrositler pek çok potansiyel nörotoksik kemoatraktan molekülün ve sitokinlerin ifadelerini arttırırlar. Nöral dokunun en dış tabakası olan, astrosit son ayakları ile vasküler yapıları çevreleyen parenkimal bir bazal membrandan oluşan glia limitans (GL), küçük moleküller ve hücrelerin beyin parankimine doğru olan hareketlerinin denetlenmesinde modifiye bir kan-beyin bariyeri gibi rol alır. Diğer dokularda organ parenkimi ile onu çevreleyen adventia tabakası arasındaki ilişki çalışılmış ve nöral dokuda bu ilişkinin adventia’dan (beyin zarları ve GL) parenkime olan yönü incelenmiş olmasına karşın, kronik Nİ’da önemli olduğunu düşünülen parenkimden adventisya’ya doğru olan etkileri çalışılmamıştır. Bu tez çalışmasında, intraserebroventriküler (İSV) lipopolisakkarit (LPS) ile indüklenen Nİ fare modelinde -ND hastalıklardakine benzer ama farklı olarak- hiperakut dönemde (2. ve 4. saatlerde) pro-inflamatuar sitokinler (İnterlökin 1 beta - IL1β, İnterlökin 6 - IL6, Tümör nekrosis faktör alfa - TNFα) ve reseptörleri (tümör nekrosis faktör reseptörü 1, 2 - TNFR1, TNFR2, interlökin 1 reseptörü 1 - IL1R1), moleküler (Western blotlama) ve görüntüleme (immünohistokimyasal işaretlemeler, aşırımlı (transmission) ve immunogold elektron mikroskopi) yöntemleriyle ilk defa GL’nin hem perivasküler (GLp), hem de teknik zorluklar nedeniyle daha zor görüntülenebilen süperfisiyal (GLs) kısımlarında araştırılmıştır. İSV LPS ile indüklenen Nİ farede modelinde 2. ve 4. saatlerde astrositik son ayaklarda şişme, bu yapıların distal kutuplarına doğru enerji kullanımının artışını destekleyen sinsityal oluşum gösteren mitokondriyonlar aşırımlı elektron mikroskobu (TEM) ile görüntülenmiştir. Aktive olan astrositlerden salgılanacak olan sitokinleri içeren veziküller TEM, veziküllerin sitokin içeriği ise TEM immünogold tekniği ile izlenmiştir. İmmünohistokimya (İHK) görüntülemelerinde aynı saatlerde astrositik aktivasyona uygun olarak IL1β yüzeyel kortikal alanlarda daha çok bulunan yüzey bağlantılı astrositlerin hem GLs’de, hem de parankime doğru inen kısımlarında gözlenmiştir. GLp’de astrosit son ayaklarının perivasküler yerleşimlerine uygun olarak aktivite artışı saptanmıştır. TNFα hem GLs hem GLp’de noktasal, sitoplazmik ve yaygın olarak gözlenmiştir. IL6 ise hem inflamatuar hem nöroprotektif özelliklerinden ve muhtemelen diğer 2 sitokine göre biraz daha geç ve az ifade edilmesinden dolayı GL’de belirgin bir paternde görüntülenememiştir. IL1R1, IL1β dağılımına benzer şekilde hem GLs hem de GLp’de izlenmiştir. Nİ’nun 4. saatinde, farelerin GL’sini içeren yüzeyel kortekslerinde Western blotlama ile IL6 ve IL1β’nın anlamlı olarak arttığı saptanmıştır. Bu bulgular, İSV LPS ile indüklenen Nİ’nin erken döneminde astrositlerde ve GL’de inflamatuar değişikliklerin ortaya çıktığını ve ND hastalık süreçlerinde astrositlerin de önemli olduğunu düşündürmektedir

The Effect Of Cadaveric Hands-On Training Model On Surgical Skills And Confidence For Transobturator Tape Surgery

Objective: To demonstrate the role of cadaveric hands-on training model on surgical skills and confidence levels of surgeons during transobturator tape (TOT) surgery. Material and Methods: A pre-test and post-test evaluation to measure skills during the practice of the steps of TOT surgery was performed on a total of 15 postgraduate urologists and gynecologists during a urogynecologic cadaveric dissection course. The course was shaped with regard to theoretical lessons, full pelvic cadaveric dissection and TOT surgery on cadavers. Results: Good handling of the TOT needle, identifying the right place for groin incision, adequate size of groin incision, identifying the right place for incision at the anterior vagina, dissection of bladder pillars from the vagina, identifying the right place at the vaginal foramina for TOT needle exit, and good placement of mesh were reviewed. The post-test scores were statistically significant for all parameters and also for self confidence level (p<0.001). Conclusion: Cadaveric workshops are important landmarks of surgical education to improve surgical skills, and gain experience and confidence.PubMedWoSScopu

Cadaveric Anatomy And Dissection In Surgical Training

Detailed knowledge of anatomy is an essential part of surgical practice. However, there are many drawbacks in anatomy education that make many residents feel inadequate when they start performing surgeries. Cadaveric dissection courses aim to close the gap between the anatomic knowledge and surgical practice. This review focuses on the role of cadaveric dissection on surgical education, and additionally states the panel decision of the Surgical Anatomy and Technologies Association on the proper use of cadavers.PubMedWo

Association of Adenoid Surface Biofilm Formation and Chronic Otitis Media with Effusion

Objectives: To investigate bacterial biofilm formation on the adenoid surface of pediatric patients undergoing adenoidectomy and to reveal whether this formation is associated with chronic otitis media with effusion (COME). Design: Prospective, single-blinded study with scanning electron microscopy. Setting: Diskapi Yildirim Beyazit Research and Educational Hospital, Ankara, Turkey. Patients: Thirty-four children between 4 and 15 years of age (mean age, 7.76 years) who had undergone adenoidectomy from June 1 through December 31, 2007, were divided into 2 groups. The first group (17 children) had undergone adenoidectomy alone, whereas the second group (17 children) had undergone adenoidectomy combined with ventilation tube insertion for COME. Main Outcome Measures: Scanning electron microscopy was performed to observe biofilm formation on the surface of adenoid tissues. The biofilm formation was graded according to extension. The roles of adenoid size, age, sex, and duration of COME symptoms were evaluated. Results: Biofilm formation was detected on all samples. Adenoids removed from patients with COME had higher-grade biofilm formation than the other group (P = .001). No correlation was found between adenoid size and biofilm formation. Conclusion: In pediatric patients, adenoid surface biofilm formation may be associated with COME etiopathogenesis.WoSScopu

Anatomic Structure Of The Internal Iliac Artery And Its Educative Dissection For Peripartum And Pelvic Hemorrhage

The abdominal aorta is divided into two parts (right and left) at the level of the fourth-fifth lumbar vertebra and called the common iliac artery. Anterior to the sacroiliac joint, common iliac arteries are divided into external and internal iliac arteries. The external iliac artery supplies the lower limb, and the internal iliac artery is the major vascular supply of the pelvis. Internal iliac artery is divided into anterior and posterior trunk. The anterior trunk supplies the pelvis, visceral organs, and the posterior trunk supplies pelvic parietal structures. The broad ligament envelopes the uterus anteriorly and posteriorly with its sheets and continues as the pelvic peritoneum at the lateral side of the pelvic wall. After cutting the pelvic peritoneum, the retroperitoneal area is visualized and the internal iliac artery with other great vessels of the abdomen can be noted.PubMedScopu