Browsing by Author "Uz, Aysun"

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    Circulus arteriosus cerebri (Willis poligonu) anatomisi; kranial bilgisayarlı tomografi anjiografi ile klinik olarak değerlendirilmesi
    (Sağlık Bilimleri Enstitüsü, 2012) Karataş, Ayşe; Uz, Aysun; Anatomi
    Circulus arteriosus cerebri was described by Thomas Willis in 1664. Willis Polygon, of which function is to protect the brain ischemia, is an arterial polygon. The aim of this study is to define structural characteristics of the Willus polygon belonging to the Turkish adult population, variations and arteries involved in the measurement of diameters and lengths on cadavers and cranial computed tomography angiography. Two groups took place in the study. Willis polygon was evaluated in 100 adult fresh human brain obtained from autopsies in the Group 1 and in 100 adult cranial computed tomography angiography in Group 2. As a result, all arteries forming the Willis polygon as 91% in Group 1 and as 71% in Group 2 were anatomically seen. The typical structure in which hypoplasia arteries is not involved was obtained as 8% in Group 1 and 28% in Group 2. The atypical Willis polygon with aplasia was seen as 9% in Group 1 and 29% in Group 2. In Group 1, 87% of adult, 9% fetal, and 4% transitional configuration in the samples were detected. In Group 2, 82% adult, 17% fetal, and 1% transitional configuration were found. The variations of the Circle of Willis in both groups were more common in the posterior portion. Hypoplasia was found to be the most common variation and seen maximum in AComP (85% in Group 1, 32% in Group 2). Aplasia was found as the second most common variation after hypoplasia and again the most common in AComP (5% in Group 1, 22% in Group 2). According to the literature, hypoplasia of AComP was high and hypoplasia of P1 was low. According to the findings obtained in this study, although computed tomography angiography is useful clinical method for demonstrating the vascular structure, because of technical difficulties for imaging of some vessels, cadaver studies is still important for evaluation of occlusive cerebrovascular disease and procedures such as bypass surgery, aneurysm.
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    Gastroözofagel bölgenin mikroskobik anatomisi veklinik önemi
    (Sağlık Bilimleri Enstitüsü, 2004) Apaydın, Nihal; Uz, Aysun; Tıp
    The anatomic structure of the gastroesophageal region that has long been surrounded by mystery shows more detailed and complicated features than its radiological and endoscopical images. The controversial structures producing the lower esophageal sphincter are not explained satisfactory enough to understand the clinical problems seen in that region and to bring forth treatment alternatives. Our aim is to bring to light the microscopic structure of that region. This study has been carried out on 13 fixed and 2 fresh cadavers. The lower esophageal sphincter, the diaphragmatic cruras, the phrenoesophageal ligament, the mucosal rosette and the sectional anaiomy of the gastroesophageal region has been examined under the dissection microscope. The histological structure of the phrenoesophageal ligament has been studied on tissue samples of 3 cadavers chosen from different age groups. Our findings show that there is an evident thickening of circular muscle layer at the gastroesophageal region. These circular muscles show an arrangement just iike plates placed on top of each other. The thickest of these muscle rings are placed at the middle of the thickening. The concordance of this arrangement with the high pressure zone located in this region is supporting the idea of presence of an internal anatomical sphincter in the lower esophageal segment. We think that the diaphragmatic crura particularly the right crus work as an external sphincter because of its plnchcock action. Since the phrenoesophageal ligament is a strong structure that firmly attaches on the esophageal wall and surrounds the upper part of the distai esophageus like a skirt, it probably has an import role in the sphincter mechanism. The histological evidences of the decrease in the collagen fibers by age and the loose arrangement of the elastic fibers due to this decrement might demolish the resistance and the elasticity of the phrenoesophageal ligament. This situation may explain the increase in predisposition to hiatal hernias by an increase in age. The mucosal folds may play a role like a valve in the sphincter mechanism since they become thicker and increase in number at the gastroesophageal region. As a result, our findings show that the sphincter structure in this region is more complicated than it is thought. For this reason, ail these structures must be kept in mind in planning the surgical procedures directed to this region and in explaining the pathologicai situations regarding the gastroesophageal region. Keywords: Gastroesophageal junction, anatomy, reflux, hiatal hernia, lower esophageal sphincter
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    Subaksiyel servikal spondilektomi cerrahisinde anatomik yapıların tespiti ve çevre yapılarla olan ilişkisi
    (Sağlık Bilimleri Enstitüsü, 2009) Şimşek, Serkan; Uz, Aysun
    Bu çalışmanın amacı, servikal spondilektomi uygulanan tümörlü omurganın en-blok olarak çıkartılması sırasında karşılaşılan kemik yapıların morfometrik özelliklerini, vasküler ve nöral dokulara olan ilişkilerin ortaya çıkarmaktır. Bu amaçla 10 adet kadavra kullanılarak bölgenin anatomisi sağlı solu 21 parametre ile değerlendirilmiştir. Bizim bulgularımıza göre servikal spondilektomi cerrahisinde posterior girişimde, a. vertebralis'in posterior'dan diseksiyonunu sağlamak amacıyla lateralde tuberculum posterius önemli bir referans nokta olarak kullanılmalıdır. Tuberculum posterius, C3 için %50 oranda massa lateralis'in inferiorundan çıkarken C4, C5 ve C6 omurları için sırası ile %60, %80 ve %60 oranında massa lateralis'in ortasından çıkmaktadır. Tuberculum posterius, massa lateralis'den 15,46±2,46 mm aşağısından sagittal plana göre 49,18±11,60 açı ile çıkmaktadır. Spondilektomi ameliyatının ikinci aşamsı a. vertebralis'in anterior'dan tespiti ve diseksiyonudur. A. vertebralis'in güvenli diseksiyonu için proc. costalis'in anatomisi ve morfometrisi iyi bilinmelidir. Çalışmamızda proc. costalis, omur gövdesinin orta noktasının 7,65±2,01mm derininden çıkmaktadır. Proc. costalis 10,07±1,6 mm genişliğinde, 7,07±1,49 mm yüksekliğinde ve 1,5±0,9 mm kalınlığındadır. İki proc. costalis arasında a. vertebralis'in serbest olarak geçtiği 9,34±1,99 mm bir riskli pencere mevcuttur. Spondilketominin anterior aşamasında a. vertebralis diseke edildikten sonra proc. uncinatus'un güvenli olarak çıkarılması için pedikülün omur üst yüzeyine olan mesafesi 4,72±1,29 mm ve omur alt yüzeyine olan mesafesinin 5,52±1,16 bilinmesi gereklidir. Subaksiyel servikal spondilektomi agresif, zor fakat tedavi edici bir tedavi yöntemdir. Bizim sonuçlarımıza göre tuberculum posterius, proc. costalis'in anatomisi ve poc. uncinatus ile pedukül ilişkisinin iyi bilinmesi vertebranin en-blok olarak çıkarılması kolaylaştıracaktır. Böylece morbitide ve mortalite oranı ile lokal nüks oranı azalacaktır. AbstractOur objective was to evaluate the relationships between the neurovascular structures and the surrounding bony structures in cervical en-bloc spondylectomy surgery. Using ten cadaveric cervical spine we measured the 21 important anatomical landmarks on both the left and the right side of the vertebra. In cervical spondylectomy surgery at posterior approach the posterior tubercle is an important anatomic landmark for the dissection of the vertebral artery. Posterior tubercle originates from the inferior margin of the lateral mass in 50% in C3 vertebra, in 60%, 80% and 60% from the midline of C4, C5 and C6 lateral mass. The angle of the posterior tubercle according to the sagittal plane was found as 49,18±11,6 0. The distance between the posterior surface of the lateral mass and the posterior tubercle was found as 15,46±2,46 mm. The second stage of the cervical spondylectomy is the anterior approach to the cervical vertebra. After dissection of the longus colli and the longus capitis muscles the cervical vertebra corpus margins are identified. The costal process is an important anatomical landmark for the dissection of the vertebral artery. The lateral dissection of the longus colli should be through the costal process. The width of the costal process was 10,07±1,6mm, the height was 7,07±1,49 mm and the depth was 1,5±0,9 mm. The height between the two neighbouring costal processes was found as 9,34±1,99 mm. The distance between the pedicle and the superior margin of the vertebra corpus was found as 4,72±1,29 mm and the distance between the pedicle and the inferior edge of the corpus was 5,52±1,16 mm which are important morphometrical parameters for the resection of the uncinate process after bilateral dissection of the vertebral arteries. Subaxial cervical spondylectomy is an aggressive but the best treatment option of the vertebra tumors. According to or results understanding the anatomy of the posterior tubercle, costal process and, relations between the pedicle and the uncinate process will improve the en-bloc spondylectomy. Thus, the morbidity, mortality and the recurrance risks of the vertebra tumors will decrease.
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    Yüz bölgesinin arteriyel perforanlarının incelenmesi ve klinik önemi
    (Sağlık Bilimleri Enstitüsü, 2009) Uysal, Ahmet Çağrı; Uz, Aysun
    Kan dolaşımı iyi bilinen yüz bölgesinin cilt perforatörlerinin çap ve çıkış yerlerinin detaylı anatomik çalışmalar ile ortaya konulması, yüz bölgesindeki defektlerde perforatör fleplerin kullanımını artıracaktır. Bu sayede ana arterleri sakrifiye etmeden, güvenli ve kolay bir şekilde kullanılacak perforatör flepler ile hasta morbiditesi ve ameliyat masrafları azaltılarak tedavi sağlanabilecektir. Çalışmanın amacı, yüzün cildini besleyen perforatör arterlerin subdermal pleksusa girdikleri yerleri, çaplarını ve sayılarını ortaya koymaktır. Bu çalışmada %10'luk formaldehit solusyonu ile fikse edilmiş beş kadavradan elde edilen 10 adet yüz yarısı kullanıldı. Kullanılan yüzler sağ ve sol olarak değerlendirildi. A. carotis communis, boyun on bölgesinde disseke edilmiştir. Kanülasyonu takiben, 200 ml lateks, fizyolojik basınç altında, manuel olarak arter içerisine verildi. Diseksiyonlar ameliyat mikroskobu (x0,4-x1,6) eşliğinde gerçekleştirildi. Tespit edilen bütün cilt perforatörlerinin çapları dijital mikrometre ile ölçülüp kayıt altına alındı. Her perforatörün, preavrikuler ön hat ve medial ve lateral kantus ile aurikula superioris hattından uzaklıkları not edilmiştir. Temporal saç çizgisi, preauriküler hat ve m. sternocleidomastoidus'un ön yüzünden cilt insizyonu yapılarak subdermal pleksusun inferior seviyesinde cilt altı yağ dokusunda perforatörler incelendi. Diseksiyon, lateralden mediale doğru yapıldı. Diseksiyonlar sonrası elde edilen uzaklık ölçümlerinin pratik olarak kullanılabilmesi için yüz 10 bölgeye ayrıldı. Preaurikuler bölge perforatörlerinin ortalama çapı 0,21 ± 0,09 mm (0,12-0,30), sayısı 17,37 ± 1,93 (15-19); submental bölge, perforatörlerin ortalama çapı 0,26 ± 0,12 mm, (0,14-0,38) sayısı 14,53 ± 1,48 (12-17); zigomatiko-orbital bölge perforatörlerin ortalama çapı 0,23 ± 0,09 mm (0,14-0,32), perforatör sayısı 10,67 ± 1,23 (8-13); bukkal bölge perforatörlerin ortalama çapı 0,43 ± 0,19 mm, (0,15-0,62) perforatör sayısı 14,73 ± 2,53 (10-17); labium inferius bölge perforatörlerin ortalama çapı 0,18 ± 0,07 mm (0,10-0,26), sayısı 12,17 ± 1,64 (10-14); labium superius bölge perforatörlerin ortalama çapı 0,19 ± 0,09 mm (0.09-0.27), perforatör sayısı 9,93 ± 1,57 (6-13); nasolabial bölge perforatörlerin ortalama çapı 0,37 ± 0,11 mm (0.15-0.47), perforatör sayısı 14,84 ± 1,93; nasal bölge perforatörlerin ortalama çapı 0,14 ± 0,06 mm (0,08-0,21), perforatör sayısı 6,11 ± 1,28 (4-8); periorbital alt bölge perforatörlerin ortalama çapı 0,12 ± 0,04 mm (0,08-0,17), perforatör sayısı 2,12 ± 1,23; üst bölgedeki perforatörlerin ortalama çapı 0,13 ± 0,03 mm (0,08-0,17), perforatör sayısı 3,24 ± 1,94; frontal bölge perforatörlerinin ortalama çapı 0,17 ± 0,04 mm (0,10-0,22), perforatör sayısı 13,81 ± 3,57 olarak bulundu. Yüz bölgelerindeki perforatör arterlerin dağılımının bilinmesi, her türlü cerrahi işlemde, ameliyat öncesi planlamada, ameliyat sonrası komplikasyon ve morbiditesinin düşürülmesinde etkin rol oynamaktadır. Ayrıca yeni fleplerin tariflenmesi, var olan fleplerin değişik varyasyonlarının gerçekleştirilmesi mümkün olacaktır. Bu nedenle, klinik anatomi çalışmalarının önemi, klinik çalışmalara ışık tutması ve yön vermesidir. Çalışmamızın bu konuda faydalı olacağını düşünmekteyiz.AbstractThe anatomical study of the skin perforators of face region would help in reconstruction of the facial defects with perforator flaps. Thus, patient morbidity, operation time and costs might be decreased without scarification of any major arterial structure. The aim of the study is to investigate the diameter and location of the arterial skin perforators of the face region. In the study, 5 formalin fixed cadavers were used. The right and left part of the face was included in the study so as to have 10 face halves. Common carotid artery was dissected at the neck region and following the cannulation, 200ml latex was injected under physiological pressure. Dissection were carried out with operating microscope (x0,4-x1,6). The skin perforators were photographed and the diameters of the perforators were measured with a digital compass. The distance of the perforators from preauricular anterior line, pupilla- lateral cantus- superior auricular line were noted. The perforators were examined from lateral to medial. Face was divided into 10 hypothetical regions to organize the data gathered from the dissection. The mean diameter of the preauricular region was 0,21 ± 0,09 mm (0,12-0,30) and the number of perforators were 17,37 ± 1,93 (15-19). For submental region the mean diameter was 0,26 ± 0,12 mm, (0,14-0,38) and the number of perforators were 14,53 ± 1,48 (12-17); for zigomatico-orbital region the mean diameter was 0,23 ± 0,09 mm (0,14-0,32) and the number of perforators were 10,67 ± 1,23 (8-13); for buccal region the mean diameter was 0,43 ± 0,19 mm, (0,15-0,62) and the number of perforators were 14,73 ± 2,53 (10-17); for inferior labial region the mean diameter was 0,18 ± 0,07 mm (0,10-0,26) and the number of perforators were 12,17 ± 1,64 (10-14); for superior labial region the mean diameter was 0,19 ± 0,09 mm (0.09-0.27), and the number of perforators were 9,93 ± 1,57 (6-13); for nazolabial region the mean diameter was 0,37 ± 0,11 mm (0.15-0.47), and the number of perforators were 14,84 ± 1,93; for nasal region 0,14 ± 0,06 mm (0,08-0,21), and the number of perforators were 6,11 ± 1,28 (4-8); for lower periorbital region the mean diameter was 0,12 ± 0,04 mm (0,08-0,17), and the number of the perforators 2,12 ± 1,23; for the upper palpebral region the mean diameter was 0,13 ± 0,03 mm (0,08-0,17), and the number of perforators were 3,24 ± 1,94; for frontal region the mean diameter was 0,17 ± 0,04 mm (0,10-0,22), and the number of perforators were 13,81 ± 3,57. The knowledge of the distribution of the skin perforators of the face region would help in the decrease of the operation complications and morbidity would benefit in preoperative planning in any surgical procedure. The design of the new flaps and the variations of the standard flaps might be feasible. Thus, this study might improve and support any clinical studies that would include the arterial anatomy of face region.