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PubMed1996

Cadaver kidney transplantation in patients more than 65 years old.

Elderly patients with end-stage renal disease often remain on dialytic therapy because they are at increased risk for mortality and morbidity. We placed 24 cadaver kidney transplants into 24 patients aged 65-74 years between September 1, 1985, and August 31, 1995. Rates of patient and graft survival were compared with those of 404 concurrent first cadaver-kidney transplant recipients between the ages of 20 and 44 years. The 5-year rates of patient and graft survival were not significantly different (86% versus 92% and 77% versus 63%, respectively; study group presented first). Primary cadaver kidney transplantation can be successfully performed in patients older than 65 years when a selection algorithm is applied to exclude active infection, active malignancy, unsuitable anatomy for technical success, high probability of operative mortality, and noncompliance. Pelvic arteriosclerosis and lower urinary tract abnormalities can cause intraoperative technical problems.

Adult↗
PubMed1996

Cross-matches on donor cadaver retinal pigment epithelial cells in corneal risk patients.

BACKGROUND: Allografts can be rejected either through the antibody-mediated or cellular pathways. The objective of this study was to look at the extent of antibody formation in patients awaiting re-keratoplasty using cross-matches on cadaver retinal pigment epithelial (RPE) cells. METHODS: Cadaver RPE cells were derived by trypsin digestion from donor eyes (n = 1200). After 3 days of cell cultivation, the cells were adherent and began to lose their pigment. By day 7 most cells were clear and grew as a polygonal monolayer. MHC class I expression by RPE cells was studied by the W6/32 (anti-HLA-A, B, C) monoclonal antibody (MoAb) and that of class II (HLA-DR) by the 136 MoAb. Normal RPE cells express few class I and no detectable class II antigens. For the induction of MHC expression, cells were subsequently stimulated with 250 U/ml of recombinant gamma-interferon for 5 days. Cells were used for tissue typing and also for cross-matches with recipient serum. Cross-matches were subsequently performed and measured by flow cytometry. RESULTS: Both class I and class II antigens were strongly enhanced, as could be shown by immunohistochemical staining. Some 20% of those patients awaiting rekeratoplasty (n = 60) were positive for anti-HLA antibodies. In one case anti-DR3 antibodies were detected in a recipient who had had several rejection episodes after keratoplasty. CONCLUSIONS: RPE cells are not only useful for cadaver post-mortem HLA typing but also for donor-specific cross-matches. The degree of antibody formation after keratoplasty in rejecting patients was, however, low. This may imply that anti-HLA antibodies are not the major cause of corneal graft loss after keratoplasty.

Antibodies, Monoclonal↗
PubMed1994

The occipitotemporal vein: a cadaver, MRI and CT study.

The author studied a superficial temporal vein running anteroposteriorly within the occipitotemporal sulcus, the "occipitotemporal vein", which, when prominent, could be thought to simulate a "venous angioma" on MRI. A cadaver (n = 50), MRI (n = 200), and CT (n = 50) study was undertaken to examine the incidence, detectability, size, location, and drainage of the occipitotemporal vein. It was an approximately 3 mm wide, 2-5 cm long structure. It was present in 83% of the cadavers (52% bilaterally), and clearly identifiable on 73% of the MRI (43% bilaterally), and 8% of the CT studies. In 18% of the cadavers the vein was totally absent, and it was not seen in 27% of the MRI examinations. The occipitotemporal vein can be distinguished from a venous angioma by its particular location and course, and by lack of intraluminal bright signal on spin-echo T2-weighted and/or contrast-enhanced T1-weighted images. In addition, venous angiomas are usually intraparenchymal, whereas the occipitotemporal vein is a superficial vessel.

Adolescent↗
PubMed1994

Laparoscopic oncologic proctosigmoidectomy with low colorectal anastomosis in a cadaver model.

The purpose of this study was to demonstrate that a standardized approach to laparoscopic proctosigmoidectomy in a cadaver model with (1) initial proximal ligation of the inferior mesenteric (IM) vascular pedicle, (2) complete mobilization of the splenic flexure, and (3) intraperitoneal stapled colorectal anastomosis can be accomplished in complete accordance with oncologic surgical principles. Using nine cadavers in the fresh state, six abdominal wall cannulas were placed so as to allow good access to the left colon and rectum. After identifying the left ureter and gonadal vessel, the IM pedicle was divided close to the aorta and the left mesocolon was separated from the retroperitoneal structures. The sigmoid colon was transected at the proximal resection line with an endoscopic stapler; then the splenic flexure and descending colon were completely mobilized. The rectum was freed circumferentially, dissected first posteriorly, laterally, and anteriorly, and then transected in its middle portion with an endoscopic stapler. The specimen was removed through a widened left-lower-quadrant trocar incision and the anvil of a circular endoscopic stapler was placed into the proximal colon extraperitoneally. An intraperitoneal laparoscopic colorectal anastomosis was performed using a double-stapled technique. The median length of specimen was 53 cm (range 45-80 cm) and the median number of removed lymph nodes was 15 (range 11-20). A careful abdominal autopsy was carried out in all cadavers. Length of remaining inferior mesenteric artery was smaller than 1.5 cm in all cases and only one remaining lymph node (3 mm in diameter) was found adjacent to the IMA in one subject. No damage to either ureter occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1999

Water flow between the upper esophagus and pharynx for the LMA and COPA in fresh cadavers. Laryngeal mask airway, and cuffed oropharyngeal airway.

PURPOSE: In this randomised, crossover cadaver study, we determine the esophageal pressure (EP) at which water flow occurs between the upper esophagus and pharynx for the laryngeal mask airway (LMA) and cuffed oropharyngeal airway (COPA). METHODS: Ten male and ten female cadavers were studied. The infusion set of a pressure controlled, continuous flow pump was inserted into the upper esophagus and ligated into place. The EP was increased in 2 cm H2O increments. This was performed without an airway device (controls) and over a range of cuff volumes for the LMA (0-40 ml) and COPA (0-60 ml). Regurgitation pressure (RP) was the EP at which fluid was first seen with a fibreoptic scope in the hypopharynx (controls) and above or below the cuff (LMA and COPA). RESULTS: The RP was higher for the LMA than for the COPA and controls (P<0.0004), and RP was similar for COPA and controls. There was an increase in RP with increasing cuff volume for the LMA from 0 to 10 ml (P<0.0001). There were no increases in RP with increasing cuff volume for the COPA. The EP at which fluid leaked above and below the cuff was similar for the LMA at all cuff volumes. The EP at which fluid leaked above the cuff was higher than below the cuff for the COPA when the cuff volume was 40 ml (P<0.0001). CONCLUSION: In fresh cadavers, the LMA provides better airway protection from fluid in the upper esophagus than the COPA.

Aged↗
PubMed2005

[Evaluation of a cadaver workshop for education in regional anesthesia].

BACKGROUND: The aim of the present investigation was to survey former participants (n=869) of a cadaver workshop using a mail questionnaire to assess the demographic data and the impact of these courses on daily practice. METHODS: The deadline for acceptance of return mail was 60 days. Descriptive statistics were employed for analysis of results. RESULTS: The response rate was 36.7% and the course was judged to be recommendable by 98.2%. The average course attendant was board certified and had spent a mean time of 9+/-6 years in anesthesiology. The highest quality and degree of subsequent practicability in daily routine was attributed to peripheral nerve block training on cadavers. Of the course participants two-thirds performed regional anesthesia procedures more often following attendance. The majority of course attendants had to defray at least a part of the course fee themselves, and one-third was required to invest leisure time to attend. CONCLUSION: Attendance of a cadaver workshop increased knowledge of clinical anatomy and enhanced performance of regional anesthesia procedures. Courses of this format constitute a currently underestimated adjunct to contemporary regional anesthesia education.

Anesthesia, Conduction↗
PubMed2007

The dural entrance of cerebral bridging veins into the superior sagittal sinus: an anatomical comparison between cadavers and digital subtraction angiography.

INTRODUCTION: Intracranial venous structures have received increasing attention due to improved neuroimaging techniques and increased awareness of cerebral venous disease. To date, few studies have attempted to investigate the dural entrance of the cerebral bridging vein (BV). The aim of this study was to use the superior sagittal sinus (SSS) as an example to identify anatomical features of the dural entrance of the BVs into the SSS in both human cadavers and digital subtraction angiography (DSA) images. METHODS: A total of 30 adult and 7 fetal human cadavers and 36 patients were examined with anatomical dissections, vascular casting and DSA. The number, diameter and angle of the BVs entering the SSS were measured and compared between the cadavers and DSA images. RESULTS: The results demonstrated that (1) the way a BV entered the SSS varied in three dimensions, and thus the BV dural entrance was difficult to precisely localize by DSA, (2) the distribution pattern of the dural entrance of the BVs into the SSS was relatively constant and a nontributary segment of the SSS was centered at the coronal suture and was identifiable by DSA, and (3) nearly all the BVs (97%, 561/581) entered the SSS at an angle opposite to the direction of blood flow. CONCLUSION: Unique anatomical features of the dural entrance of a BV into the SSS should be considered in neuroimaging interpretation of the sinus and its associated veins.

Adolescent↗
PubMedDate not supplied

Endovascular placement of an extraluminal femoropopliteal bypass graft in human cadavers.

PURPOSE: A method to create an extraluminal femoropopliteal bypass graft using endovascular techniques was evaluated in situ on cadaver extremities in an attempt to develop a minimally invasive alternative technique for the management of infrainguinal occlusive arterial disease. METHODS: The endovascular placement of an extraluminal femoropopliteal bypass graft was undertaken in 5 cadaver legs. Following percutaneous access to the popliteal artery (PA) or common femoral artery (CFA), a Rosch-Uchida needle was used to perforate the vascular wall, followed by the creation of an extraluminal tract using a looped wire and catheter. Once the desired level was reached the needle was again used to perforate the vascular wall of the proximal superficial femoral artery (SFA) or PA depending on the access used. Self-expanding expanded polytetrafluoroethylene (ePTFE) stent-grafts were then deployed to establish the extraluminal femoropopliteal bypass connecting the two arterial puncture sites. Following dilatation of the stent-graft, angiography was performed to assess the endoprostheses and to look for contrast leaks. RESULTS: Technical success was achieved in all 5 legs. Procedure time varied from 15 to 30 min. The angiographic studies performed immediately after completion of the bypass procedure showed patency of the grafts with no evidence of kinking or leakage in any of the cases. CONCLUSION: This study has proved that the endovascular placement of an extraluminal femoropopliteal bypass graft in human cadaver legs using endovascular techniques under fluoroscopic control is technically feasible.

Angiography↗
PubMed2001

Hoffa's recess: incidence, morphology and differential diagnosis of the globular-shaped cleft in the infrapatellar fat pad of the knee on MRI and cadaver dissections.

We frequently observed a fluid-like indentation at the inferior posterior margin of Hoffa's fat pad of the knee and sought to establish the incidence and differential diagnostic criteria of this cleft. In total, 133 MRI studies and 35 cadaver specimens were analyzed for the location, size, and shape of clefts at the inferior posterior margin of Hoffa's fat pad. The incidence of a fluid-like ovoid cleft on MR images was 13.5% and in cadavers 14.3%. The cleft was located just below the insertion of the infrapatellar synovial fold (plica synovialis infrapatellaris, ligamentum mucosum). More linear-shaped indentations at the posterior margin were visible in all patients and cadavers due to the horizontal course of the alar folds. A fluid-filled indentation within the inferior posterior margin of Hoffa's fat pad has to be expected in more than 10% of knee studies and should not be confused with tumors like ganglion cysts. We term this cleft the infrahoffatic recess. One hypothesis of its origin concerns the embryological regression process of the infrapatellar membrane into the infrapatellar synovial fold. It should not be confused with linear clefts due to the alar folds.

Adult↗
PubMed2002

JC virus genotyping offers a new means of tracing the origins of unidentified cadavers.

There has been no reliable means of tracing the origins of unidentified cadavers but the recent finding that JC virus (JCV) can serve as a means of elucidating human migrations suggested that this virus may also be useful to trace the origins of unidentified cadavers. DNA samples extracted from renal tissue and urine were used as the template for PCR amplification of a 610 bp region (IG region) of the viral genome. We detected JCV DNA in 45% of the renal samples and in 33% of the urine samples and was detectable even 10 days after death. The sequences of the amplified IG regions could be used to determine the genotypes. We conclude that the JC virus genotype is a new marker useful for tracing the origins of unidentified cadavers.

Cadaver↗
PubMed2005

Depth of endoscopically placed sutures: an experimental study in a human cadaver model.

BACKGROUND: Endoscopic suturing devices offer interesting access for interventional procedures used on the gastrointestinal tract. For the time being, the main indication is endoluminal suturing at the gastroesophageal junction for the management of gastroesophageal reflux disease. There is some evidence that endoluminal endoscopic suturing offers an alternative to the closure of esophageal fistulas and to the fixation of feeding tubes and stents in the near future. A review of the literature found no anatomic data on wall layers stitched by sutures. The aim of this study was to determine the depth of sutures placed endoscopically in the esophagus of a human cadaver model. METHODS: Altogether, 62 sutures were placed in the esophagi of 10 cadavers (complete exenterative cadaver model) at three different suction levels (0.4, 0.6, and 0.8 bar) using the EndoCinch suturing machine. After preparation of the esophagus from its mediastinal bed, all sutures were fixed in formalin and stained with hematoxylin and eosin for histologic examination. RESULTS: No sutures were placed in the mucosa alone. As observed, 1.6% were placed in the submucosa, 4.8% in the circular muscularis propria, and 56.5% in the longitudinal muscularis propria, with 37% placed transmurally. At a suction level of 0.4 bar (0.6, 0.8 bar), 0% (0%, 1.6%) were placed in the submucosa, 3.2% (0%, 1.6%) in the circular muscularis propria, and 11% (25.8%, 12.9%) in the longitudinal muscularis propria, with 12.9% (6.5%, 17.7%) placed transmurally. CONCLUSIONS: This study reports, for the first time, a systematic examination of the depth of sutures placed endoscopically in the esophagus. Most of the sutures were found in the muscular wall of the esophagus at a suction level of 0.6 bar. Also, transmural placements were seen. Reduction of suction pressure may lead to a decrease in transmural sutures.

Aged↗
PubMed2000

Intestinal retractor for transperitoneal laparoscopic aortoiliac reconstruction: experimental study on human cadavers and initial clinical experience.

BACKGROUND: We set out to design a bowel retractor for use during laparoscopic transperitoneal reconstruction of the infrarenal aorta and of both iliac axes. METHODS: This study was performed on five cadavers. After the insertion of four trocars, a pneumoperitoneum was created, and the bowels were gathered to the right flank. On each cadaver, the following four measurements were made: the distance between the Treitz angle and the aortic bifurcation (L1), the distance between the aortic bifurcation and the right internal inguinal ring (L2), the angles between L1 and L2 in the axial plane (A1), and the angles between them in the sagittal (A2) plane. These measurements enabled us to create a bowel retractor. The device was composed of a malleable metallic rod with a 2.5-mm diameter that was fixed to the operating table and whose intraabdominal section was designed to follow the outline of the mesenteric root in addition, a 25 x 12 cm polypropylene net was slipped around the rod. The infrarenal aorta and both iliac axes were then dissected. Secondarily, the bowel retractor was used in eight patients (seven men and one woman; mean age, 56 years; range 44-76) during laparoscopic aortoiliac reconstruction for occlusive (n = 6) or aneurysmal (n = 2) disease. RESULTS: The statistical analysis of the measurements performed on cadavers showed a significant correlation between body height and L1 (r = 0.8769; p < 0.05) and L2 (r = 0. 9706; p < 0.01) distances. It was then possible to design the shape of two metallic rods (one small and one large) so that they would be adaptable to the height of the patients (<1.65 m and >1.65 m). During our clinical experience, all laparoscopic procedures were completed in a mean operative and clamping time of 266 min (range, 215-360) and 54 min (range, 18-90), respectively. Mean postoperative hospital stay was 6 days (range, 3-13). CONCLUSION: Our experimental study allowed us to develop a bowel retractor that can make it easier to perform laparoscopic transperitoneal aortoiliac reconstruction in humans.

Adult↗
PubMed2006

Bilateral femoral hernia in a male cadaver with vascular variations: case report and review of the literature.

Femoral hernia, which is a less common occurrence than inguinal hernia, is not congenital in most cases and is uncommon in young males. It is considered to be more common in females than in males due to an enlarged femoral ring in the former. A case of bilateral femoral hernia in a 64-year-old male cadaver is described within the framework of an anatomical approach. On the right side, the protrusion of the viscus appeared as a small intestine coil, whereas on the left side the protruded viscus appeared as a pelvic colon's appendix appiplocae. On both sides, the protruded viscus was located in front of an aberrant obturator artery, which oriented from the external iliac artery and not from the internal iliac artery as should be the case. The puberal branch of the inferior epigastric artery was absent. The cadaver's medical history and his skin examination excluded an abdominal surgery. In the literature, case reports of bilateral femoral hernia appear only seldom, especially those of male patients who had not undergone inguinal hernia repair surgery. In femoral hernias more often than in other types of hernia, the protruded viscus is strangulated and undergoes a tissue necrosis. Morbidity and mortality for complicated femoral hernia is high. Knowledge of vascular variation such as presented by the cadaver under study is extremely useful to the surgeon because any iatrogenic injury of the aberrant obturator artery during a laparoscopic repair may result in dangerous hemorrhage.

Arteries↗
PubMed2002

Prospective, randomized, controlled trial of proximally based vs. distally based gluteus maximus flap for anal incontinence in cadavers.

PURPOSE: The aim of this study was to compare the lengths of proximally based and distally based gluteus maximus flaps created as for anal sphincter reconstruction in soft human cadavers. METHODS: Twelve soft cadavers were used in this prospective, randomized, controlled study. In each cadaver, a proximally based flap of the gluteus maximus muscle was performed on one side and a distally based flap on the other. All flaps were carefully dissected with neurovascular preservation by one surgeon. After the dissected flap was placed across the anus, the length of the flap that projected beyond the anus was measured. The differences between such lengths of both types of flaps were assessed by paired t-test. RESULTS: The average lengths of the parts that projected beyond the anus for proximally based and distally based flaps were 8.08 and 4.50 (standard deviation, 0.51 and 0.79) cm, respectively. The average difference was 3.58 (standard deviation, 0.51) cm, which was statistically significant (P < 0.001). CONCLUSION: Results showed that proximally based flaps were significantly longer than distally based flaps and that transposition and wrapping around the anus with proximally based flaps were always easily performed without tension. These findings support the use of unilateral proximally based gluteus maximus flaps instead of unilateral or bilateral distally based flaps in patients with anal incontinence. The location of the neurovascular pedicle of the gluteus maximus was consistent at 1 cm superior and lateral to ischial tuberosity. Knowledge of this landmark allows quick and safe dissection of the gluteus maximus flap.

Buttocks↗
PubMed1978

A ten year experience with cadaver kidney preservation using cryoprecipitated plasma.

Between August 1967 and January 1977, 699 cadaver kidneys were preserved and transplanted in our hospital after continuous perfusion with cryoprecipitated plasma. Overall graft survival of primary transplants was 55 +/- 2 per cent at one year and 41 +/- 2 per cent at four years. The results with ninety-six second transplants were similar. The number of HLA antigens shared and the duration of preservation did not influence graft survival. Patient survival among 426 cadaver graft recipients since September 1972, when lower dose immunosuppression was started, was 91 +/- 1 per cent at one year and 84 +/- 2 per cent at four years, significantly better than survival before then. Survival of fifty-two recipients of cadaver retransplants since September 1972 was 86 +/- 5 per cent at one year and 86 +/- 5 per cent at four years, which was better than before. The incidence of posttransplantation dialysis was 30 per cent and did not correlate with the length of preservation. Primary wound infections, primary ureteral extravasation, and vascular complications each occurred with an incidence of 1.1 per cent or less in patients treated with lower dose immunosuppression. Only four kidneys were lost because of complications, and in no instance was the need for transplant nephrectomy directly related to the method of preservation. Perfusion preservation with cryoprecipitated plasma gives excellent results compared with alternative methods.

Adolescent↗
PubMed1984

Measuring the inertial properties of cadaver segments.

The purpose of this study was to devise and test a method of determining the inertial properties of frozen cadaver segments, including the principal moments of inertia. Balsa wood segment holding boxes were developed and tested on a variety of test objects and on one sixteen segment cadaver. The method was both time efficient and accurate, yielding absolute percentage errors of approximately 1% +/- 1% for each of the three principal moments of inertia based on 110 tests for each parameter. The time required to test each cadaver segment did not exceed 30 min.

Cadaver↗
PubMed1982

Comparison of standard immunosuppression with adjuvant antilymphoblast globulin in primary cadaver kidney transplant survival.

Adjuvant, prophylactic, antilymphoblast globulin and standard immunosuppression have produced comparable long-term cadaver kidney graft survivals at separate institutions. A comparison was made of 35 primary cadaver kidney grafts into recipients treated with prophylactic, adjuvant antilymphoblast globulin to 55 recipients of primary cadaver kidney grafts treated with standard immunosuppression. Antilymphoblast globulin delayed early rejection episodes (P under 0.05), making early post-transplant management simpler. There were no significant differences between the two groups with respect to graft losses due to rejection at any interval beyond one month.

Antilymphocyte Serum↗
PubMed1991

Survival of DNA HLA-DR typed and matched cadaver kidney transplants. The Collaborative Transplant Study.

The clinical value of serological HLA matching for cadaver kidney transplantation remains uncertain because the success rate for HLA-matched cadaver transplants is lower than that of HLA-matched sibling grafts. Up to 25% of serological HLA-DR typings may be incorrect when compared with a more accurate DNA-RFLP method, and we have now examined whether incorrect HLA-DR typings account for the lower than expected success rates of HLA-matched cadaver transplants. 58 transplant centres took part in this study and DNA was extracted from over 4000 samples of frozen tissue at the study centre. 8 laboratories then completed blind RFLP typing for HLA-DR. Serological typing data were reported by individual transplant laboratories. 29 of 107 transplants (27%) that were reported as HLA A, B, DR compatible and 76 of 273 (28%) transplants that were reported as HLA B, DR compatible according to serological typing were found to be HLA-DR mismatched by DNA typing. The one-year transplant success rate for DNA-matched HLA, A, B, DR grafts was 87% compared with 69% for mismatched grafts (p less than 0.02); the corresponding success rate for DNA-matched HLA B, DR grafts was 85% compared with 72% for mismatched grafts (p less than 0.01). Many transplants that were previously thought to be HLA matched are mismatched, and this finding may account for previously unexplained graft failures.

Cadaver↗