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Öğe Anatomical landmarks regarding sacrospinous colpopexy operations performed for vaginal vault prolapse(Elsevier Sci Ireland Ltd, 2002) Sağsöz, N.; Ersoy, M.; Kamaci, M.; Tekdemir, I.Aim: To investigate the anatomical relationships of the structures and the topographic anatomy or the sacrospinous ligament and validate Current anatomic knowledge of this area. Materials: Nine embalmed half female cadaver pelvises were dissected to reveal the anatomy of the sacrospinous ligament. Results: The average length of the sacrospinous ligament was measured to be 43.04 +/- 6.58 mm. The inferior gluteal complex emerges from the infrapiriform foramen at a distance of 17.02 +/- 3.08 mm from the ischial spine and courses to inferior laterally with a slight curve. During this course, it passes close to the upper-lateral half of the sacrospinous ligament. The pudendal complex passes above the spine in six of the nine cases (66.6%) and lies maximum of 5.5 mm medial to the spine. Oil average the sciatic nerve is measured to he 25.14 +/- 3.94 mm lateral to the ischial spine. Conclusion: Placing the suture inferomedially and close to sacrum, the risk of complication will be minimal. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.Öğe Certain anatomical relations and the precise morphometry of the infraorbital foramen-canal and groove: An anatomical and cephalometric study(Lippincott Williams & Wilkins, 2001) Kazkayasi, M.; Ergin, A.; Ersoy, M.; Bengi, O.; Tekdemir, I.; Elhan, A.Objectives: To determine and to standardize the certain anatomical relations, and the precise size, course, and location of the infraorbital foramen, canal, and groove for facilitating surgical and invasive procedures. Study Design: This anatomical study consisted of two main steps, namely, the examination of skulls and the cephalometric analysis of the skulls. Measurements of the skulls and of the radiograms were performed. Methods: Thirty-five adult bony heads (70 sides) were studied regarding the localization and dimensions of the infraorbital groove (IOG), infraorbital canal (IOC), and infraorbital foramen (IOF) as well as their relationships with different anatomical landmarks. The cephalometric analysis of the skulls was measured for evaluating the relationships of certain anatomical points and the distances of the skulls in the cephalometric analysis. For this purpose, 13 different distances and two angles were measured on anteroposterior and lateral craniographies. Differences between data of skull and cephalogram measurements were analyzed by the Student t test. The Pearson correlation test was used in the statistical analysis of the 15 values in the cephalogram. Results: Examination of the 70 sides of the 35 bony heads revealed that the shape of the IOF was oval in 34.3%, round in 38.6%, and semilunar in 27.1% of all skulls. The IOF was single in 94.3% and double in 5.7% of the cases. The average distance from the IOF to the infraorbital margin and to the lateral process of the canine tooth in vertical direction and to the lateral nasal border in horizontal direction were 7.19 +/- 1.39 mm, 33.94 +/- 3.15, and 17.23 +/- 2.64 mm, respectively. In cephalometric analysis, when S-N (the distance between the center of the sella turcica and the nasion) and N-ANS (the distance between the nasion and the anterior nasal spine) distances were used as independent parameters for the linear analysis, the correlation of the three values for both independent parameters were statistically significant. Conclusion: While the IOF has no statistically significant changes with regard to the size of the skull, expressive changes take place in the course and the length of the IOG and IOC. Meticulous preoperative evaluation of the IOF and the route of the infraorbital nerve are necessary in patients who are candidates for maxillofacial surgery and regional block anesthesia If these measurements are taken into account, there will be little surgical risk, and this will be helpful in identifying the extent of the operative field.Öğe Comprehensive microsurgical anatomy of the jugular foramen and review of terminology(Elsevier Sci Ltd, 2001) Tekdemir, I.; Tuccar, E.; Aslan, A.; Elhan, A.; Ersoy, M.; Deda, H.The microsurgical anatomy of the jugular foramen was studied in 12 formalin preserved cadavers (24 foramina) and 40 dry-skulls (80 foramina). The jugular foramen was exposed by microsurgical dissection with drilling from a superior to inferior direction. Observations regarding dural architecture of the jugular foramen and relationships between neurovascular structures passing through the foramen were noted in cadavers. Normal bony construction of the foramen and its variational anatomy were examined in dry-skull specimens. Using photographs and drawings, the anatomy of the jugular foramen is presented and related terminology is discussed in the light of a literature review. (C) 2001 Harcourt Publishers Ltd.Öğe The effect of carnitine on random-pattern flap survival in rats(Lippincott Williams & Wilkins, 2001) Tellioğlu, A.T.; Uras, K.A.; Yilmaz, T.; Alagozlu, H.; Tekdemir, I.; Karabağ, O.Carnitine is an endogenous cofactor involved in the transport of long-chain fatty acids into the mitochondria where they undergo P-oxidation. Through another reaction, carnitine produces free coenzyme A and reduces the ratio of acetyl-coenzyme A to coenzyme A, thereby enhancing oxidative use of glucose, augmenting adenosine triphosphate synthesis, and reducing lactate production and acidosis. Because of its regulatory action on the energy flow from the different oxidative sources, especially under ischemic conditions, carnitine has been used in cardiovascular diseases such as coronary heart disease, congestive heart failure, peripheral vascular disease, dyslipidemia, diabetes, and chronic renal diseases with satisfactory results. A flap is also a relatively ischemic tissue and may obtain benefit from carnitine. To investigate this, 30 rats were divided into three groups of 10 animals: a control group and two carnitine-treated groups. Random dorsal skin flaps were elevated on the rats. In the control group, no pharmacologic agents were used. Of the two treated groups, group I was treated with 50 mg/kg/day carnitine for I week and group 2 was treated with 100 mg/kg/day carnitine for I week. The areas of flap necrosis were measured in each group. The median areas of flap necrosis of the groups were 12.55, 9.23, and 4.9 cm(2), respectively. There was a statistically significant improvement of flap necrosis in carnitine-treated groups compared with the control group (group 2, p = 0.001; group 3, p = 0.000). Furthermore, there was less necrosis in the high-dose carnitine-treated group than the low-dose carnitine-treated group. As a conclusion, carnitine may have a dose-dependent effect to increase flap survival in random skin flaps.Öğe The effect of changing pressures on dural puncture and leak with various spinal needles on an in vitro model(Churchill Livingstone, 2002) Apan, A.; Uz, A.; Ugur, H.C.; Tekdemir, I.Postdural puncture headache is one of the most serious complications of spinal anesthesia. In this study, spinal needles of various types and shapes were used to investigate the amount of fluid leakage in dural puncture under various pressures. Dura samples received from 10 cadavers were fixed in an in vitro model. The dural punctures were inflicted with 22 G, 25 G, and 27 G Quincke; 25 G Withacre; 25 G, 27 G Pencan, and 26 G Atraucan spinal needles. The fluid, which leaked during the process, was collected under the pressures of 0, 25, 50, 100, and 150cm H2O in a one-hour period for each level. The holes in the dura were studied under the light microscope. While 22 G and 25 G Quincke needles were used, the fluid leakage directly correlated with the amount of liquid, the diameter of the needle, and the pressure used. The puncture of 25 G Withacre and 25 G Pencan presented a leakage which did not significantly vary with the liquid pressure and was of lesser amount. In 26 G Atraucan, 27 G. Pencan, and 27 G Quincke inflicted punctures, little liquidwas collected and it did not vary with differing pressures. Thus, no significant correlation was established between the needle diameter and the puncture. It was concluded that the sharp-ended needles could not endure changes in the pressure. However, those needles with a very thin diameter and a pencil tip were considered as safe tools for anesthetic practice. (C) 2002 Elsevier Science Ltd. All rights reserved.Öğe Epipteric bones in the pterion may be a surgical pitfall(Georg Thieme Verlag Kg, 2003) Ersoy, M.; Evliyaoglu, C.; Bozkurt, M.C.; Konuşkan, B.; Tekdemir, I.; Keskil, I.S.Background: The pterion, the most commonly used neurosurgical landmark, is defined as the junction of frontal, parietal, and greater wing of the sphenoid and the squamous part of temporal bones. Our aim was to identify the variations of the pterion which may be a potential surgical pitfall. Methods: Both sides of 300 adult skulls were examined but 110 sides were eliminated since their pterion could not be identified owing to a damage. The shortest distance between the lateral orbital rim and the most anterior junction of the four bones forming the pterion was measured on all sides. Results: Out of 490 sides the pterion was found to contain epipteric bones in 44 (9%), and in these skulls the most anterior junction of the bones may be as close as 16 mm to the lateral orbital rim. Conclusion: In skulls with an epipteric bone variation, particularly the anterius and proprium types; the pterion can mistakenly be assessed to be at the most anterior junction of bones and a burr hole placed over there may cause inadvertent penetration into the orbit.Öğe Important anatomical structures used in paravaginal defect repair: cadaveric study(Elsevier, 2004) Ersoy, M.; Sagsoz, N.; Bozkurt, M.C.; Apaydin, N.; Elhan, A.; Tekdemir, I.Objective: To examine the variations and the anatomical characteristics of the tendinous arch of pelvic fascia (TAPF), the tendinous arch of levator ani (TALA) and the obturator fascia (Ofa) that are important structures in paravaginal defect repair and their relations with important neurovascular structures. Study design: We carried our study on 10 pelvic halves of five female cadavers fixed in 10% formaldehyde. Results: TALA could show a very high location or a low location near to inferior edge of obturator internus. TAPF was not observed in four of the cases. It was examined as a quite weak structure in two of the cases. The location of obturator vessel-nerve bundle could show difference. Obturator artery (OA) and vein sometimes do not course parallel to obturator vein (OV) and make an inclination and extend to the obturator foramen (OF). The distance between TAPF and the pectineal ligament (PL) (Cooper ligament) was measured as 5 cm on average. The distance between TAPF and the entrance of obturator canal was measured as 3.2 cm on average. While the distance of pudendal vessel-nerve bundle from levator am (LA) at the anterior border of the spine was 0 mm, 2 cm anteriorly it was measured as 4.4 mm on average. Conclusion: Since TAPF does not develop in every case, it is not a safe structure to be used in surgery. If TALA develop downward as a variation, it could be difficult to distinguish from TAPE Since the obturator fascia is a thin membrane, it is not a strong structure for suture placement. The region that is 2 cm in front of the ischial spine (IS) is a dangerous zone for pudendal vessel-nerve bundle. (C) 2003 Elsevier Ireland Ltd. All rights reserved.Öğe Innervation pattern of the abductor digiti minimi muscle of the hand(Churchill Livingstone, 2002) Gudemez, E.; Tekdemir, I.; Uslu, M.; Eksioglu, F.; Elhan, A.This cadaver study investigated the innervation patterns of the abductor digiti minimi in Guyon's canal. There was only one branch to the abductor digiti minimi in 22 of the 30 specimens. Two branches were found in three hands, and three branches in two. Three other variations were documented.Öğe The morphometric and cephalometric study of anterior cranial landmarks for surgery(Georg Thieme Verlag Kg, 2008) Kazkayasi, M.; Batay, F.; Bademci, G.; Bengi, O.; Tekdemir, I.Objective: The aim of this work was to determine reliable bony landmarks for the anterior skull base and to standardize some specific dimensions among the frontal sinus and neighboring structures for safe anterior cranial surgery. Methods: The study consisted of a topographical anatomic examination and cephalometric analysis of the skull. Thirty adult skulls (60 sides) were studied regarding the localization and dimensions of the supraorbital foramen (SOF), frontal sinus (FS), frontozygomatic fissure, infraorbital foramen, anterior nasal spine, and nasion. Differences between the measurement of skulls and cephalograms were analyzed by Student's t test. The Pearson correlation test was used for statistical analysis of the cephalogram. Results: Examination of the 60 sides of the bony heads revealed that the shape of the SOF was a foramen in 25 sides (41%), a notch in 29 sides (49%), and a groove in 6 sides (10%). A total of 20 (33%) SOFs were inside the FS and the mean distance was 6.3 + 1.34 mm from the lateral border of the sinus, 27 (45%) of SOFs were outside of the FS and the mean distance was 8.8 + 2.01 mm, and 13 (22%) of SOFs were at the border of the FS. According to our measurements the medial border of the craniotomy should be placed approximately 43 mm lateral to the nasion to avoid entering into the frontal sinus. Conclusion: To plan and to decide the convenient and safe anterior midline skull base approach and to avoid postoperative complications, bony landmarks and anatomic measurements around the SOF and FS will be helpful for the surgeon to constitute a simplification of topographic anatomy.Öğe Reliability of the safe area for the superior gluteal nerve(Lippincott Williams & Wilkins, 2003) Eksioglu, F.; Uslu, M.; Güdemez, E.; Atik, O.S.; Tekdemir, I.The authors investigated the reliability of the safe area, which previously was defined to prevent injury to the superior gluteal nerve during the lateral approach to the hip, and its relation to body height. The distance between the point of entry of the superior gluteal nerve into the gluteus medius muscle and the greater trochanter, in the regions which were defined as the anterior and posterior halves of the muscle, were measured in 23 cadaveric hips. There was a significant correlation between the height of the cadavers and the distance in the anterior and posterior regions. In all of the anterior regions and 78% of the posterior regions of the hips, the superior gluteal nerve as found to be in the safe area. The current study showed that the average distance between the innervation point of the gluteus medius muscle and the greater trochanter might change as a function of body height. The risk of damage to the superior gluteal nerve may be higher if the direct lateral approach to the hip is used. These data show that it is possible that the safe area is not always safe.Öğe Surface landmarks and anatomic relationships of sciatic nerve for anaesthetic blockade: cadaveric study(Lippincott Williams & Wilkins, 2004) Apan, A.; Uz, A.; Tekdemir, I.; Elhan, A.…
