The carotico-clinoid foramen is the result of ossification either of the carotico-clinoid ligament or of a dural fold extending between the anterior and middle clinoid processes of the sphenoid bone. It is anatomically important due to its relations with the cavernous sinus and its content, sphenoid sinus and pituitary gland. In this study the ossification state of the carotico-clinoid ligament, the diameter of the internal carotid artery and the carotico-clinoid foramen has been studied on 50 autopsy cases. Of the 100 carotico-clinoid foramina examined, in 27 sides (15 right, 12 left) the carotico-clinoid ligament was completely ossified, in 18 sides (9 right, 9 left) the carotico-clinoid ligament was incompletely ossified and in 55 sides (26 right, 29 left) it was a ligamentous structure. The correlation of the dimensions of the carotico-clinoid foramen and the internal carotid artery showed no statistical significance, except between the carotico-clinoid foramen with a fibrous carotico-clinoid ligament and the internal carotid artery on the right side (p=0.007, r=0.51). The existence of a bony carotico-clinoid foramen may cause compression, tightening or stretching of the internal carotid artery. Further, removing the anterior clinoid process is an important step in regional surgery; the presence of a bony carotico-clinoid foramen may have high risk. Therefore, detailed knowledge of the type of ossification between the anterior and middle clinoid processes can be necessary to increase the success of regional surgery.

The common carotid artery (CCA) bifurcation is of clinical importance due to its vascular access site for intravascular intervention. Additionally, it is also one of the most common sites of atherosclerotic plaque formation. There are numerous studies on the diameters of CCA, internal carotid artery (ICA), and external carotid artery (ECA) in adults, but few studies on newborns. Cadaver and angiographic studies have shown dimensional variations in the carotid arteries within/between individuals and also between different sexes. It is well known that the initial lesions of atherosclerosis begin very early in fetal life. Therefore, it is important to know the anatomical details of the CCA and its branches. In the present study, the neck regions of 20 (11 males and 9 females) fixed newborn cadavers were dissected. The CCAs were cut below the bulb of the carotid bifurcation further; ICA and ECA were cut above the bulb of the carotid bifurcation. The internal diameters of the CCA, ICA, and ECA were measured using a light microscopy. ECA/CCA, ICA/CCA, ICA/ECA ratios, and outflow to inflow area ratio were calculated. The mean outflow to inflow area ratio was 1.14+/-0.28. Our results highly correlated with the defined optimal ratio (1.15). The ECA/CCA, ICA/CCA, and ICA/ECA ratios were 0.78+/-0.12, 0.71+/-0.13, and 0.93+/-0.16, respectively. There were no statistically significant differences between male and female and also between right and left sides. These findings are of importance in understanding the anatomy of carotid artery during newborn period.

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IntroductionThe duration of pain after rib fracture is the question physicians are most frequently asked. The duration of pain following a traumatic rib fracture without any comorbidity is not widely published.AimWe report our experience to investigate the duration of pain following isolated traumatic rib fractures without any traumatic comorbidity.Material and methodsWe examined 182 patients with isolated rib fracture without any trauma to other body parts. The numeric rating scale (NRS) for pain was used to rate the level of pain. The NRS pain scores were evaluated in the emergency department at presentation, on the 15th day, and at the 3rd and 6th months of trauma. The Mann-Whitney U test was performed for the statistical analysis.ResultsThe pain level of young patients on the 15th day and at the third month and sixth month was lower than that in the old group, and the difference was statistically significant. While patients with two rib fractures had a higher pain level in the emergency room than those with one rib fracture, there was no statistically significant difference at other time points. In patients with anterior fractures, the pain level was significantly lower than in the lateral and posterior regions, whereas in the lateral fractures, the pain score was significantly higher than others at all time points except at the 6th month. The pain score of displaced fractures was significantly higher than that of non-displaced ones at all time points except the 6-month follow-up.ConclusionsRib fractures cause significant pain and need appropriate medication. The time of the 6th month could be an important milestone.

We studied the cerebellar connections to the reticular nucleus thalamus (RNT) by means of retrograde axonal transport of horseradish peroxidase (HRP) in the rat. Specific HRP pressure injections to the rostral RNT (1.6-1.8 mm caudal to bregma) resulted in retrograde labelling of neurones in the cerebellar nuclei. The rostral RNT showed specific topographical organization of its cerebellar connections. Microinjections into the rostral RNT, 1.6 mm caudal to bregma, produced numerous HRP-labelled neurones within the anterior interposed (emboliform nucleus) and scarce HRP-labelled neurones within the lateral (dentate nucleus) cerebellar nuclei, whereas injections into the rostral RNT, 1.8 mm caudal to bregma, produced numerous HRP-labelled neurones within the posterior interposed (globose nucleus) and scarce lightly HRP-labelled neurones within the lateral (dentate nucleus) cerebellar nuclei.

Purpose: The aim of the present study was to fixate displaced sternum fractures with a nonspecific plate, without a sternotomy procedure. Method: Between May 2010 and December 2011, 15 patients with sternal fractures were included in this study. We performed fixation for 8 of 15 sternal fracture patients. Posteroanterior and lateral chest x-rays and computed tomography were taken for diagnosis of sternal fractures. Our surgical indications were severe pain, dislocationoverlapping of sternal edges, and thoracic wall instability. Locked volar distal radius plates were used for the sternal fixation. Results: After fixation of sternum with plate, the sternum was stable in all 8 patients. There were no complications intra-or postoperatively. Sternal union was observed for all. Pain relief was determined dramatically. Conclusion: Locked volar distal radius plates can be used for displaced sternal fractures. It is an alternative and successful method for sternal fractures.Keywords: sternal fracture, trauma, fixation of sternum IntroductionSternal fractures account for 0.45% to 4% of all the recorded admissions in emergency departments. 1 2 They are usually caused by car accident, fall or direct blunt chest trauma.Diagnosis of sternal fractures is sometimes difficult for physicians in emergency conditions. Because a lateral, plain chest radiograph is not usually obtained during the initial trauma evaluation, chest computed tomography is an important diagnostic tool, and coexistence of other problems could be determined. The usual medical approach to sternal fractures is conservative treatment that includes analgesics, rest, and usage of a sternal corset. We think that surgical correction of sternal fractures should be made to prevent intractable and chronic pain, and instability and deformity of the thoracic wall. 4 There is no standard surgical technique to fix the sternum. We report fixation of sternum fractures with a different material, in eight patients. Materials and MethodsBetween May 2010 and December 2011, 15 patients with sternal fractures were included in this study who had severe traumas and admitted to our hospital. The mean age of patients was 38 years (range, 20-62 years). All of the patients were seen at the emergency room. 10 of them had additional systemic injuries, like brain contusion, intracranial hemorrhage, splenic rupture, liver and/or lung contusion, pneumothorax and/or hemothorax, flail chest, displaced extremity fractures. A plain chest radiograph and whole body computed tomography Posteroanterior and lateral chest x-rays and computed tomography were taken for diagnosis of sternal fractures. Our surgical indications were severe pain, dislocationoverlapping of sternal edges, and thoracic wall instability. Locked volar distal radius plates were used for the sternal fixation. Results: After fixation of sternum with plate, the sternum was stable in all 8 patients. There were no complications intra-or postoperatively. Sternal union was observed for all. Pain relief was determined dramatically. Conc...

The vascular anatomy of the lung and possible variations of the pulmonary artery should be well known by surgeon to prevent complications. The various branching pattern of the pulmonary arteries should be determined to prevent excessive and unnecessary resection with life-threatening bleeding.

Spontaneous pneumothorax that occurs in patients with no underlying lung disease is termed primary spontaneous pneumothorax (PSP). Recurrence of pneumothorax is usually seen without surgical procedures at any time. The aim of this study was to determine the recurrence time and rate of PSP after the first episode. A total of 82 PSP patients who had been treated in a thoracic surgery clinic between March 2011 and August 2012 were studied retrospectively. Video-assisted thoracoscopic surgery (VATS) was performed in 14 of 82 patients because of prolonged air leakage. These patients were excluded from the study to determine the recurrence period of PSP in our cases. Simple endotracheal intubation with low-volume high-frequency ventilation and three-port VATS technique were applied. Bullae or blebs were excised using an endoscopic linear stapler. Apical pleurectomy was performed in all of the patients. There were no cases in which VATS was converted to open thoracotomy. Recurrence of PSP was seen in 18 (26.47 %) of 68 patients. We found 26.47 % recurrence at the first 7 months, of which 94.4 % occurred at the first 6 months. About 77.77 % of these recurrences occurred at 3 months after discharge from hospital. Recurrence after the first episode of PSP is a common problem within the first 6 months. The thoracic surgeon should give knowledge about it to all patients. With the greater use of VATS for thoracic pathologies, it could be performed for the first period of pneumothorax in the future.