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    Bilateral Anterior Inferior Iliac Spine Avulsion in an Adolescent Soccer Player: A Typical Imitator of Malignant Bone Lesions
    (Lippincott Williams & Wilkins, 2009) Karakas, Hakki Muammer; Alicioglu, Banu; Erdem, Gulnur
    Avulsion fractures are usually diagnosed easily in acutely presented cases. The diagnosis becomes definite if clinical and radiological follow up reflect the fracture's healing phase. A 13-year-old soccer player with bilateral anterior inferior iliac spine (AIIS) avulsion, who had been examined in other institutions with a pre-diagnosis of malignancy, is reported. Clinically, such cases display the importance of medical management of athletic injuries by specially trained physicians. From the perspective of preventive medicine, the high incidence of AIIS injuries-during soccer games, and the bilateral nature of the damage mandate a review of the training programs and shooting techniques for adolescent players.
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    Bile duct anatomy of the Anatolian Caucasian population: Huang classification revisited
    (Springer France, 2008) Karakas, Hakki Muammer; Celik, Tayfun; Alicioglu, Banu
    Background and objectives Living donor liver transplantations (LDLT) donor candidates are being assessed with MRCP (magnetic resonance cholangiopancreatography) to identify their suitability for standard surgical techniques. Variations of the bile duct anatomy play an important role in donor selection and in the selection of the resection technique. If bile duct anatomy is misrecognized, complications may occur. Anatomic variations are classified according to the origin of the right posterior hepatic duct (RPHD). According to the so called Huang classification, type A1 is the most, and type A5 is the least frequent variation. These frequencies were initially validated on Chinese population. Later studies revealed significant variability in frequency for the so called trifurcation, the variation in which a common junction of RHPD, right anterior hepatic duct (RAHD) and left hepatic duct (LHD) (A2) exists. In this study we aimed to determine the bile duct anatomy variations for the Anatolian Caucasians. Methods One hundred and thirty-four healthy subjects were investigated under 1.5 T MRI, with breath-hold (expiration) heavily T2-weighted turbo spin echo (TSE) static fluid imaging (TR/TE = 8,000/800). The sequence has permitted three to five oblique coronal thick sections (40 mm) around a common axis. Sequences were repeated until anatomically interpretable images were obtained. Diagnostic images could not be obtained in 22 subjects. Radiologists who were fully experienced in LDLT assessment investigated these images, and classified them for the surgical variations of the bile duct anatomy. One hundred and twelve subjects (58 men, 54 women) who were classified were between 14 and 81 years of age (mean: 39.3; SD 14.1). According to Huang classification, 61 of them (55%) were classified as type A1 (normal right and left hepatic duct junction), 16 (14%) as type A2 (common junction of RAHD, RHPD and LHD), 24 (21%) as type A3 (aberrant drainage of RPHD to left main duct), and 11 (10%) as type A4 (aberrant drainage of RPHD to main hepatic duct). When subjects, in whom the distance (d) between RPHD insertion and the right and left hepatic duct junction is less than 1 cm, are classified as type A2, the type A1 prevalence decreases to 28%. For the entire population that distance was between 3 and 25 mm (mean: 9.8, SD: 4.8). Accordingly, the frequency of type A1 anatomy was 8-29% lower than the respective frequency in Chinese population. Conclusion From the surgical perspective, close proximity (d < 1 cm) of RPHD to right and left hepatic duct junction is considered as type A2 variation. According to that concept, type A1, usually accepted as the dominant anatomic variation, is encountered only in 28% of the Anatolian Caucasians. We have proposed a modified surgical classification in which Huang type 2 was subdivided into types K2a (close proximity) and K2b (trifurcating). The predominance of K2 types in the population of the study may necessitate the use of bench ductoplasty in many liver grafts.
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    Imaging Features of the Total Anomalous Pulmonary Venous Connection to the Portal Vein Shown by Multidetector Computed Tomography Angiography
    (Springer, 2009) Karakas, Ilakki Muammer; Alicioglu, Banu; Kandaz, Asli
    [Abstract Not Available]
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    The subpubic angle in sex determination: Anthropometric measurements and analyses on Anatolian Caucasians using multidetector computed tomography datasets
    (Elsevier Sci Ltd, 2013) Karakas, Hakki Muammer; Harma, Ahmet; Alicioglu, Banu
    Introduction and aim: The investigation of new anatomical criteria and revalidation of existing ones in sex determination for different populations are among main research foci of forensic anthropometry. In that context, the pelvis is the most extensively studied bone. A number of qualitative classifications, dimensional measurements and indices have been proposed for investigative anthropometry and forensic studies. Independent use of these parameters generally provided an accuracy rate of 70-75%. In this study, the accuracy rate of the subpubic angle in sex determination was investigated in living Anatolian Caucasians. Material and method: The subpubic angle was identified and measured on three-dimensional computed tomographic images of pelves. Data were obtained using 64-detector computed tomography (MDCT) with an isotrophic resolution of 500 mm. The sample included 66 males (41.6 +/- 14.9 years of age) and 43 females (41.1 +/- 14.2 years of age). Measurements were taken on a dedicated three-dimensional image analysis workstation. The subpubic angle was electronically measured. The technique and methodology was validated on a standard skeletal model. Intraobserver agreement was analyzed with intraclass correlation coefficient, and intraobserver variability was evaluated with technical error of measurement (inter-and intra-observer TEM), relative technical error of measurement (rTEM) and coefficient of reliability (R) measures. The subpubic angle for the study group and for both sexes was reported as minimum-maximum (mean +/- SD). Independent-Samples T Test for equality of means was used to determine the difference between the two sexes regarding the subpubic angle. The correlation between the subpubic angle and the age of subjects were using Pearson Correlation Coefficients in males and in females. Logistic regression model was used to classify subjects according to their sex. Receiver operating characteristic curve analysis was performed to determine a cut-off value for further studies and to test the performance of the binary classification test. Results: Intraclass correlation for the subpubic angle (0.990), TEM (1082), rTEM (1.492), and R (0.990) represented almost complete reliability and accuracy of the measurement method. The subpubic angle was between 48 degrees and 81 degrees (65.9 degrees +/- 7.2 degrees) in males and was between 64 degrees and 100 degrees (82.6 degrees +/- 7.7 degrees) in females. Statistically significant difference was found between males and females regarding the subpubic angle (p < 0.0001). The subpubic angle was not significantly correlated with age in males (p = 0.953), or in females (r = 0.975). The accuracy of the subpubic angle in sex determination was 90.8%. With a cut-off value of 74 degrees, sensitivity of subpubic angle to detect female phenotype was 88% and its specificity was 95%. Conclusion: The subpubic angle is an accurate parameter in sex determination with high sensitivity and specificity. (C) 2013 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
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    Total body height estimation using sacrum height in Anatolian Caucasians: multidetector computed tomography-based virtual anthropometry
    (Springer, 2011) Karakas, Hakki Muammer; Celbis, Osman; Harma, Ahmet; Alicioglu, Banu
    Estimation of total body height is a major step when a subject has to be identified from his/her skeletal structures. In the presence of decomposed skeletons and missing bones, estimation is usually based on regression equation for intact long bones. If these bones are fragmented or missing, alternative structures must be used. In this study, the value of sacrum height (SH) in total body height (TBH) estimation was investigated in a contemporary population of adult Anatolian Caucasians. Sixty-six men (41.6 +/- 14.9 years) and 43 women (41.1 +/- 14.2 years) were scanned with 64-row multidetector computed tomography (MDCT) to obtain high-resolution anthropometric data. SH of midsagittal sections was electronically measured. The technique and methodology were validated on a standard skeletal model. Sacrum height was 111.2 +/- 12.6 mm (77-138 mm) in men and 104.7 +/- 8.2 (89-125 mm) in women. The difference between the two sexes regarding SH was significant (p < 0.0001). SH did not significantly correlate with age in men, whereas the correlation was significant in women (p < 0.03). The correlation between SH and the stature was significant in men (r = 0.427, p < 0.0001) and was insignificant in women. For men the regression equation was [Stature = (0.306 x SH) + 137.9] (r = 0.54, SEE = 56.9, p < 0.0001). Sacrum height is not susceptible to sex, or to age in men. In the presence of incomplete male skeletons, SH helps to determine the stature. This study is also one of the initial applications of MDCT in virtual anthropometric research.