Determination of sex from the tibia of adult Turkish cadavers

The aim of this research is to determine sex from the tibia. The tibia is an ideal bone because it resists erosive forces and keeps its anatomical shape for a long time even after being buried. Additionally, we tried to obtain a higher discrimination rate by using the biarticular breadth that was accepted as the most valid criterion in previous sex discrimination studies which were directed to the proximal part of the tibia. Right and left tibiae from 55 randomly selected adult Turkish cadavers (25 to 68 years) were measured to the nearest millimeter performed with a caliper; a total of six dimensions, one from the proximal and five from the distal ends, was measured. Canonical discriminant function test was performed to develop formulae and assess the accuracy of the technique. The results indicated that classification accuracy ranged from 89% in the right and 87% in the left for biarticular breadth. There was a minimal difference between the sides and the height of the medial malleolus. In conclusion, the distal and proximal dimensions of the tibia are highly discriminative as the sexual dimorphs in this Turkish sample. The study compares well with those on blacks and whites of North America and South Africa.     

An unusual content of the inguinal canal: The external pudendal vein

Summary In a 43-year-old male cadaver the external pudendal vein ran an abnormal course in both inguinal regions. On each side the vein passed through the superficial inguinal ring, and after a short course in the canal pierced the inguinal ligament and drained into the femoral vein. The significance of this rare relation between the external pudendal vein and the inguinal canal is discussed from the embryological, surgical and diagnostic point of view.     

Dribbling of Urine due to Ectopic Vaginal Insertion of an Upper Pole Ureter Diagnosed by Magnetic Resonance Urography

Imaging the urinary tract in children has been mainly based on ultrasound (US) and intravenous pyelography (IVP), but these imaging modalities rarely show ectopic insertion of the ureter and the condition is often under diagnosed due to unusual clinical presentations. Recently newer magnetic resonance urography sequences have been developed that provide better delineation of the urinary tract. We report a 3-year-old girl presenting continuous dribbling of urine in which magnetic resonance urography revealed ectopic vaginal insertion of the ureter.     

Plasma and urine nitric oxide levels in healthy Turkish children

Nitric oxide (NO) is an important messenger molecule with a wide range of actions in virtually all cell systems and organs. In kidneys it participates in glomerular and medullary hemodynamics, tubuloglomerular feed-back, renin secretion, and extracellular fluid balance. Although the role of NO in regulating renal function in adults is well-established, it has recently been suggested that NO has a more critical role in maintaining basal renal blood flow and glomerular filtration rate (GFR) in the developing kidney. NO is rapidly metabolized to the stable end products nitrite and nitrate, which are more slowly excreted into the urine. Thus these metabolites can be recommended as useful markers of endogenous NO synthase activity, despite limited data about age-related changes in in-vivo NO production. The aims of this study were to determine age-related normal reference values of serum and urinary NO metabolites and to assess the probable relationship between these metabolites and the GFR. Normal levels of NO end products in blood and urine of 296 healthy children (117 female, 179 male) between the ages of 0 and 16 were investigated, as was whether these values change with age. Serum and urinary nitrate levels did not differ according to sex. Serum nitrate levels are higher in younger children, especially in the newborn period, and decrease with age. Nitrate levels in urine are higher in younger children with a peak in infancy (1 month to 1 year) and decrease with age. It was demonstrated that this decrease in serum and urinary nitrate levels with age parallels the increase in GFR. In conclusion, urinary NO products may be an indirect marker of serum NO levels and NO might have an important regulatory function both in the maintenance of renal function and in the maturation of the developing kidneys.     

Laryngeal reconstruction by platysma myofascial flap after vertical partial laryngectomy

BACKGROUND: Many methods of glottic reconstruction have been described for patients undergoing vertical partial laryngectomy to reestablish the glottic integrity. METHODS: Fifteen patients with T2 squamous cell carcinoma of the glottis were included in this prospective clinical trial. All patients were treated by vertical partial laryngectomy with laryngeal reconstruction by platysma myofascial flap. The surgical procedure and flap design were described. Vocal function was assessed by videolaryngostroboscopy and subjective and objective voice analysis before and after surgery. RESULTS: Complete neoglottic closure and acceptable voice quality were obtained by platysma myofascial flap in all cases. No statistically significant difference was found between the preoperative and postoperative acoustic parameters. CONCLUSIONS: Platysma myofascial flap provides the basic requirements for laryngeal reconstruction with its own favorable characteristics and also allows complete glottic closure without interfering with respiration and deglutition. This technique may be an effective alternative achieving an acceptable quality of voice.     

Successful salvage therapy of resistant gestational trophoblastic disease with etoposide,methotrexate, actinomycin-d,etoposide, cisplatin (EMA/EP)

A 26-year-old woman who had been treated for nonmetastatic gestational trophoblastic tumor with three courses of methotrexate with folinic acid rescue and had been lost to follow up for 4 years was referred with the fractional curettage diagnosis of choriocarcinoma that had been performed for abnormal vaginal bleeding. Her serum beta human chorionic gonadotropin (βhCG) was 706,000 mIU/mL and there were multiple pulmonary metastatic foci. The uterus was 12 weeks pregnant-size and a 6×6-cm tumor mass was seen within the anterior uterine wall at ultrasonography. Following total abdominal hysterectomy etoposide, methotrexate, actinomycin-D, vincristine and cyclophosphamide (EMA/CO) regimen was given. Whole brain radiation of 30 Gy in 3 weeks for brain metastasis, discovered in magnetic resonance imaging was given after the first course. Since serum βhCG levels plateaued after three courses of chemotherapy and multiple pulmonary metastases persisted, treatment was shifted to etoposide, methotrexate, actinomycin-D, etoposide, cisplatin (EMA/EP) regimen. She was in remission after three courses of chemotherapy.     

The new perilaryngeal airway (CobraPLA) is as efficient as the laryngeal mask airway (LMA) but provides better airway sealing pressures

The Laryngeal Mask Airway (LMA) is a frequently used efficient airway device, yet it sometimes seals poorly, thus reducing the efficacy of positive-pressure ventilation. The Perilaryngeal Airway (CobraPLA) is a novel airway device with a larger pharyngeal cuff (when inflated). We tested the hypothesis that the CobraPLA was superior to the LMA with regard to insertion time and airway sealing pressure and comparable to the LMA in airway adequacy and recovery characteristics. After midazolam and fentanyl administration, 81 ASA physical status I-II outpatients having elective surgery were randomized to receive an LMA or CobraPLA. Anesthesia was induced with propofol (2.5 mg/kg IV), and the airway was inserted. We measured 1) insertion time; 2) adequacy of the airway (no leak at 15-cm-H2O peak pressure or tidal volume of 5 mL/kg); 3) airway sealing pressure; 4) number of repositioning attempts; and 5) sealing quality (no leak at tidal volume of 8 mL/kg). At the end of surgery, gastric insufflation, postoperative sore throat, dysphonia, and dysphagia were evaluated. Data were compared with unpaired Student's t-tests, chi2 tests, or Fisher's exact tests; P < 0.05 was significant. Patient characteristics, insertion times, airway adequacy, number of repositioning attempts, and recovery were similar in each group. Airway sealing pressure was significantly greater with CobraPLA (23 +/- 6 cm H2O) than LMA (18 +/- 5 cm H2O, P < 0.001). The CobraPLA has insertion characteristics similar to the LMA but better airway sealing capabilities.     

99mTc ethylene dicysteine scintigraphy for diagnosing cortical defects in acute pyelonephritis: a comparative study with 99mTc dimercaptosuccinic acid

AIM: To evaluate the clinical usefulness of early cortical phase images in the diagnosis of acute pyelonephritis and to compare the measurements of differential renal function obtained by both 99mTc ethylene dicysteine (99mTc-EC) and 99mTc dimercaptosuccinic acid (99mTc-DMSA). METHODS: Forty-three children who had undergone both 99mTc-EC and 99mTc-DMSA studies within 5 days of acute infection were studied. Cortical images of 99mTc-EC were obtained by the sum of the renogram frames achieved between the first 60-120 s of the renogram study. DMSA and EC images were visually interpreted using four points of semiquantitative ratings: 0, normal; 1, mild hypoactivity; 2, moderate hypoactivity with partial loss of margins; 3, marked hypoactivity with loss of cortical margins. Values for the differential renal function were obtained for both studies. RESULTS: DMSA detected a total of 109 lesions in 36 patients and EC detected 90 lesions with a sensitivity of 82.5%. 99mTc-EC successfully detected moderate-to-severe cortical lesions but was less effective with mild lesions (sensitivity 60%). Bland-Altman analysis demonstrated good agreement among the results for differential renal function (95% CI -0.26 to 0.96). CONCLUSION: 99mTc-EC early phase images detected most of the cortical lesions. Its sensitivity depends on the severity of the lesions. EC provided reliable information in the estimation of differential renal function.     

The sinus node artery: anatomic investigations based on injection-corrosion of 60 sheep hearts

The purpose of this study was to investigate the sinus node artery in the sheep heart to establish adequate baseline information for use in cardiovascular research, and to compare this information with similar data for man. The coronary arteries were exposed by using injection-corrosion casting technique in 60 sheep hearts. Polyester and diluted sulfuric acid were used. When the corrosion was completed, the specimens were photographed. The sinus node artery was single in 59 specimens, and double in one specimen. The artery originated from the right coronary artery (in 42 specimens), left coronary artery (in 16 specimens), and right aortic sinus (in 1 specimen). In the majority of specimens, sinus node artery corresponded to the right superior (anterior) atrial artery. Pericaval termination was common. Mean measurements about the sinus node artery were tabulated. According to the present study, we can state that the sinus node artery in sheep heart is similar to that of humans. Because of the importance of animal research, we suggest that experimental surgical studies of the sinus node artery should be performed on the sheep heart.