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At least 199 records · Page 11Linked to original sources
PubMed2006

Teaching anatomy: cadavers vs. computers?

Our study was aimed to show if cadaver dissections are still important in the Anatomy Course for medical students or whether computerized resources could replace them. We followed three groups, one of them (698 students) proceeded through the Anatomy Course in a traditional way, meaning, with cadaver material enough to observe all the regions and structures; the second group (330 students) used many technological resources but not cadaver dissections; and the third group (145 students) followed the course, recently, with the same program but with both practical resources. Theoretical contents were developed in the same way and by the same professor. The traditional teaching group obtained better results than the technologically supported group, evaluated by the number of students that passed their exams. The third group results were better than the others, with regard to passed exams and marks. Even when computerized improvements have developed a new area giving students a lot of elements to facilitate their approach to imaging structures, the possibility of direct contact with tissues and anatomical elements cannot yet be replaced. We are demonstrating that the best possibility is the correct association of all these resources to complement one another.

Anatomy↗
PubMed2007

Ultrasonographic confirmation of intraosseous needle placement in an adult unembalmed cadaver model.

STUDY OBJECTIVE: Intraosseous access is widely used in pediatric and adult resuscitations when vascular access cannot be promptly established. Confirmation of intraosseous needle placement has traditionally relied on the ability to aspirate blood or marrow or infuse crystalloid easily. This study's aim is to determine the value of bedside ultrasonography as a means of confirming intraosseous needle placement by visualizing the flow of crystalloid within the intraosseous space. METHODS: A controlled trial was conducted in which intraosseous access was obtained in the bilateral distal tibia of 4 freshly frozen, unembalmed cadavers. In 8 legs, an intraosseous needle (15-gauge Jamshidi) was inserted 1 fingerbreadth superior to the medial malleolus and flushed with 10 mL of crystalloid. Measurements included whether crystalloid was observed to flow by gravity into the drip reservoir of the intravenous tubing and whether color flow was visualized within the intraosseous space of the tibia with a 5- to 10-MHz linear transducer in color power Doppler mode, positioned just cephalad to the intraosseous needle. Intraosseous needles were then intentionally placed into the subcutaneous space just posterior to the distal tibia, and these measurements were repeated. Two blinded observers reviewed ultrasonographic video recordings and rated the presence or absence of color flow within the intraosseous space. RESULTS: Intraosseous color flow on ultrasonography correctly identified all placements, but flow into the drip reservoir was incorrect for one of the intraosseous lines (P=1.0 versus ultrasonography) and 6 of the subcutaneous lines (P=0.31 versus ultrasonography). There was perfect interobserver agreement (kappa=1) during video review. CONCLUSION: In freshly frozen cadavers, ultrasonographic visualization of flow within the intraosseous space may be a reliable method of confirming intraosseous placement. The observation of flow into the drip reservoir appears to be an unreliable indicator of intraosseous placement in fresh frozen cadavers.

Adult↗
PubMed2004

The zygomatic bone as a potential donor site for alveolar reconstruction--a quantitative anatomic cadaver study.

The aim of this cadaver study was to evaluate the possibility of using the zygomatic bone as an intraoral bone harvesting donor site and to determine the safety of this harvesting procedure. In addition, the volume of bone material harvested from the zygomatic bone was measured. Twenty fixed adult cadavers were used to yield a total of 40 zygomatic bone harvest sites, from which bone was collected. The volume of bone obtained from the zygomatic harvests was measured with a water displacement method and by compressing the graft into a syringe. The safety of the technique was evaluated by assessing possible encroachment upon the neighbouring structures. After bone harvesting, the zygomatic sites were exposed and evaluated for visible perforations or fractures. Possible damage to the neighbouring tissues was also examined with computed tomography scans at 18 sites in nine cadavers. The average bone graft volume obtained from the zygomatic bone was measured to be 0.53 ml (SD 0.25) with water displacement and 0.59 ml (SD 0.26) with the syringe. The complications in the zygoma included 15 small perforations into the maxillary sinus and 7 perforations into the infratemporal fossa. CT scans showed that bone could be harvested safely without encroaching upon the orbital floor or the surrounding nerves and vessels in the zygoma. The zygomatic bone is a safe intraoral donor site for the reconstruction of small- to medium-sized alveolar defects.

Adult↗
PubMed2006

Body esteem as a moderator of cardiovascular stress responses in anatomy students viewing cadaver dissections.

OBJECTIVE: Anatomy training requires students to take courses involving the dissection of human cadavers. It is suspected that such tuition is stressful for some students more than for others. Terror management theory suggests that the mortality salience presented by cadaver dissections would heighten stress among those students with positive self-images. The present study sought to investigate the association between body esteem (BE) and cardiovascular stress reactivity to cadaver dissections. METHODS: The study involved the measurement of cardiovascular stress responses in 36 anatomy students during a dissection class. Psychometric assessments of BE and other variables were taken. RESULTS: Students with high BE had lower heart rate (P=.011) and exhibited greater decreases in systolic blood pressure (P=.008) and pulse pressure (P=.003) throughout the session, suggestive of maladaptive stress response. CONCLUSIONS: As findings are consistent with theories linking BE with stress in occupations that require workers to view dead bodies, the consideration of BE may be an effective component in stress reduction interventions.

Adaptation, Psychological↗
PubMed2004

Some sociocultural aspects of cadaver organ donation: recent rulings from Iran.

Cultural and social factors strongly influence cadaveric organ donation and removal. In Muslim countries such as Iran, there is general public resistance to removal of organs despite clear rulings from religious leaders. Recently, some religious authorities have waived family permission and allowed cadaver organ removal even if the deceased person had not made a declaration for organ donation. Scholars have also exempted physicians from paying a legal penalty for removing organs in such cases. Cadaver organ donation is also allowed if the deceased person has made a declaration that money obtained from the recipient be spent to pay his debts or for public welfare and that the organ be used to save a life. There is no restriction on organ donation between people of different religions in normal circumstances. We conclude that these rulings should positively influence present sociocultural cadaver organ donation trends in Iran.

Cadaver↗
PubMed1989

Recent results of cadaver kidney retransplantation.

The results of secondary cadaver renal transplantation in 42 patients treated from 1980 to 1986 have been reviewed. The initial graft was from a cadaver donor in all cases. All patients were managed with a maintenance immunosuppressive regimen, including either antilymphoblast globulin and/or cyclosporine. The over-all 1 and 2-year patient survival rates were 97 and 94 per cent, respectively. The over-all 1 and 2-year graft survival rates were 69 and 63 per cent, respectively. Graft success was not influenced by patient age greater than 50 years, diabetes, initial graft removal, interval between initial graft removal and retransplantation, duration of initial graft function, level of presensitization or HLA-Dr antigen matching. Currently, cadaver renal retransplantation can be performed safely and with an improved opportunity for graft success. Patients who return to dialysis after losing an allograft should be encouraged to consider another transplant for the same reasons that prompted initial transplantation.

Adolescent↗
PubMed1987

Repeat cadaver kidney transplantation using cyclosporine A immunosuppression.

Repeat cadaver kidney transplantation using azathioprine immunosuppression carried a higher risk of graft loss than primary transplants. We analyzed the results of repeat cadaver kidney grafting with cyclosporine A immunosuppression. A total of 33 cyclosporine A-treated patients received the second kidney transplant at varying intervals after failure of the first transplant. Graft survival at 1 year was 66 per cent. A concurrent group of 189 cyclosporine A-treated first cadaver kidney recipients had a 1-year graft survival rate of 75 per cent, although this better result was not statistically significant (p greater than or equal to 0.25). A historical group of 31 azathioprine-treated second graft recipients had a significantly worse 1-year graft survival rate of 45 per cent compared to the cyclosporine A second graft group (p less than 0.1). Patient age, sex, early first graft loss, interval between transplants and the presence of panel reactive antibodies were not factors in predicting second graft outcome. A complete DR mismatch appeared to worsen the second transplant survival. These findings indicate that early graft survival of cyclosporine A-treated repeat cadaveric transplants is acceptable and is better than azathioprine-treated first or second grafts.

Actuarial Analysis↗
PubMed1985

Pediatric cadaver kidney transplants into adults.

During a 5-year period 77 adults received single kidney cadaver transplants from donors 16 months to 16 years old. Cyclosporin immunosuppression was not used. Three recipients had ischemic ureteral complications, 1 of which resulted in allograft loss. Of the kidney grafts 34 were from donors 8 years old or younger, and comparison of renal function was made with the 43 adult recipients of cadaver kidneys from older children. The mean 1-month serum creatinine nadir was significantly higher in the recipients of kidneys from the younger children (2.6 plus or minus 1.6 versus 1.9 plus or minus 0.8 mg./per dl.). There were no statistically significant differences in 1-week dialysis requirement, 1-month kidney graft function or actuarial kidney graft survivals and serum creatinine levels at 3, 6, 12 and 24 months after grafting. Cadaver kidneys from young donors can be transplanted successfully into adults.

Adolescent↗
PubMed1983

Improved results of cadaver renal transplantation in the diabetic patient.

The results of 54 renal transplants performed on 48 patients with end stage renal disease and insulin-dependent diabetes mellitus are reported. Pre-transplant screening with coronary angiography was done to determine the presence and severity of coronary artery disease and left ventricular dysfunction. There were 12 living related donor (group 1) and 42 cadaver renal transplants. The cadaver transplant recipients were grouped further into those who received additional prophylactic immunosuppression with antilymphoblast globulin (group 2, 18 patients) and those who received standard immunosuppression with azathioprine and prednisone (group 3, 18 patients). The 2-year patient and graft survival rates in groups 1 to 3 were 81 and 67, 88 and 69, and 61 and 32 per cent, respectively. The use of prophylactic antilymphoblast globulin for adjunctive immunosuppression resulted in significantly improved graft survival among cadaver recipients (p less than 0.003). Selection of patients for transplantation on the basis of preliminary screening with coronary angiography was found to have a major impact on patient survival.

Adult↗
PubMed1982

Determinants of allograft survival in 100 consecutive cadaver kidney transplants.

We reviewed 100 consecutive cadaver renal transplants done at our clinic between April 1976 and October 1979. A minimum 1-year followup was available on all patients. The actual 1-year graft survival rate was 64 per cent and the actual 1-year patient survival rate was 91 per cent. Criteria that had no significant effect on 1-year allograft survival were performance of pre-transplant nephrectomy and/or splenectomy, red blood cell group or the level of pre-formed antibody. A major determinant of graft survival was the number of blood transfusions received before transplantation. The 1-year graft survival rate was 36 per cent with no pre-transplant transfusions, 64 per cent with 1 to 5 transfusions and 70 per cent with more than 5 transfusions (p less than 0.005). The 1-year graft survival rate was not influenced by the use of kidneys imported from other states, the use of pediatric cadaver donors 1 to 15 years old or extended renal preservation times. Our experience supports continued regional and national sharing of adult and pediatric cadaver donor kidneys with extended preservation times.

Adolescent↗
PubMed2002

Insertion of the minimally invasive direct cardiac massage device (MIDCM): training on human cadavers.

OBJECTIVE: Recently, a new device for minimally invasive direct cardiac massage (MIDCM) has been developed. In animal models of cardiopulmonary resuscitation MIDCM has been shown to provide better organ perfusion than external chest compressions (ECC) massage. Since this device has been developed to improve cardiopulmonary resuscitation in humans, its use must be simple. Thus, we measured the time required for the insertion of the MIDCM device on human cadavers. DESIGN: After a 1 h theoretical course, physicians and surgeons were asked to use the MIDCM device on human cadavers. We measured the time from the cutaneous incision to the first direct cardiac compression. MAIN RESULTS: The mean time required for the insertion of the MIDCM device was 16+/-11 s (range 8-58 s). The insertion time required for each group of physicians were as follows, 15+/-8 s for anaesthesiologists (range 8-28 s), 11+/-2 s for cardiac surgeons (range 9-15 s), 42+/-14 s for cardiologists (range 27-58 s), and 12+/-4 s for intensive care physicians (range 8-18). All participants compared the insertion of the MIDCM device favorably with the insertion of a chest drain. CONCLUSION: The MIDCM device can be placed in a few seconds in human cadavers by physicians familiar with chest drain insertion. Theoretical course and training with the device may be useful especially for those who are not familiar with chest drain insertion.

Cadaver↗
PubMed1998

Increased complex formation of Gc globulin with actin in plasma from human cadavers.

Gc globulin binds actin at an equimolar ratio with a high affinity. It has been revealed that complexes of Gc with actin are present in the plasma of human cadavers. In the present study, an immunoassay which we developed using a specific anti-Gc monoclonal antibody was applied to evaluate the complexed Gc in cadaver plasma. The percentage of Gc in the complexed form was found to be 38.3 +/- 19.8% (n = 45), and a significantly higher percentage was observed in the plasma of cadavers from burn death. However, the plot of the complex percentage against the time since death showed a relatively low correlation, with a coefficient (r) of 0.51. This was supposed to be due to different environmental conditions after death. Since the complex formation represents the release of cytoplasmic actin into plasma from collapsed cells, the phenomenon should be noted in forensic postmortem chemistry.

Actins↗
PubMed1989

Surgically induced astigmatism in human cadaver eyes.

A human cadaver eye model was used to study the effects of various sized limbal and scleral-pocket-type incisions on corneal astigmatism. Limbal incisions of 5.0 mm and 10.0 mm and scleral pocket incisions of 3.5 mm and 7.0 mm were carefully placed in human cadaver eyes. These wounds were closed in a uniform fashion, first loosely and then tightly, using interrupted 10-0 nylon sutures. Pre-incision and post-incision keratometer readings were taken and the net change in astigmatic error was calculated. The results indicate that tighter sutures, larger wound size, and limbal rather than scleral-pocket-type incisions were associated with a greater degree of immediate postoperative astigmatism in the cadaver eye.

Astigmatism↗
PubMed1998

A comparative study of structures comprising the thoracic outlet in 250 human cadavers and 72 surgical cases of thoracic outlet syndrome.

OBJECTIVE: We have hypothesized that variations in fibrous, muscular and osseous structures with the potential to entrap the brachial plexus occur within the thoracic outlet of the normal population; and that these variations are different in pattern and frequency from those in patients presenting with thoracic outlet syndrome (TOS). METHODS: Structural anomalies with potential for entrapping elements of the brachial plexus were examined following dissections of the posterior triangle of the neck in 250 human cadavers (N = 500 thoracic outlet dissections) and catalogued jointly by an anatomist and a thoracic surgeon. The pattern and frequency of anomalies in the 250 cadavers was compared to that encountered in 72 surgical cases of removal of the first rib for relief of symptomatic TOS (N = 72 procedures, 55 patients). RESULTS: Relevant structural variations were encountered in 46% of cadavers, exhibiting no left right or gender preference overall. When compared with the surgical group in which 100% exhibited structurally relevant anomalies, significant differences in pattern of anomalous structures and gender distribution were revealed. Anomalies posterior to the brachial plexus, ranging from fibrous bands to cervical ribs in both groups, were prevalent in the surgical group. A 'scissors-like' pattern, with neural entrapment by anterior and posterior anomalies was frequently encountered in females. CONCLUSIONS: Based on these data and embryological considerations, we propose a revised and simplified classification of impingement mechanisms within the anatomic thoracic outlet. Comparing these data to radiological imaging and observations at surgery, we offer a new perspective for the investigation and management of patients with TOS.

Cadaver↗
PubMed2002

Accuracy of cricothyroidotomy performed in canine and human cadaver models during surgical skills training.

BACKGROUND: Surgical skills training is an integral component of the Advanced Trauma Life Support (ATLS) Course. Teaching techniques are continuously reevaluated and updated. Recognition of recurring technical errors in the performance of cricothyroidotomy in canine models prompted this comparison to the performance of the procedure in human cadavers. STUDY DESIGN: Thirty-three ATLS physician students performed cricothyroidotomy in canine models. Ten flight nurses performed a bimonthly surgical skills practicum on similarly prepared animals. Neck specimens were excised, fixed, and later mapped by the investigators. Subsequent courses used human cadavers obtained through the Wright State University School of Medicine Anatomical Gift Program. Cricothyroidotomy sites were mapped in situ. RESULTS: In the canine models, 47 necks with 52 attempted cricothyroidotomies were inspected and mapped by the investigators. Four specimens had multiple tracheotomy sites: three had two and one had three. If these multiple attempts are excluded from analysis, 13 of the 43 cricothyroidotomies in the canine models were misplaced (30.2%). Cricothyroidotomy placement in human cadavers was correct in 27 of 28 attempts (96.4%). CONCLUSIONS: It is imperative that cricothyroidotomy, a high-risk procedure, be taught in an appropriate model to best prepare students to perform it in a life-saving situation. Placement accuracy in canine models is low. Alternative models for teaching this procedure should be considered.

Animals↗
PubMed2002

Assessing the emotional impact of cadaver dissection on medical students.

AIM: The study's first aim was to assess the emotional impact of cadaver dissection on first year medical students using the newly developed Appraisal of Life Events Scale (ALE). Its secondary aim was to evaluate the validity of the ALE by comparing it with the Impact of Events Scale (IOE). SETTING: Division of Biomedical Sciences, School of Biology, University of St. Andrews. SUBJECTS AND METHOD: Appraisal of Life Events and Impact of Events data were obtained from 114 UK medical students 4 weeks after their first cadaver dissecting class. Main outcome measures referred to the ALE and IOE scales. RESULTS: The students rated the experience as largely positive, registering significantly higher scores on the ALE challenge factor than on ALE threat or ALE loss. Significant correlations between ALE threat and loss scores and IOE intrusions and avoidance scores were noted. CONCLUSION: The results indicate that medical students do not report their first exposure to cadaver dissection as an aversive experience. Instead, as the ALE results confirm, they found it to be a positive and challenging life event. The ALE appears to be a useful instrument in assessing positive and negative emotional reactions to significant life events.

Adaptation, Psychological↗
PubMedDate not supplied

Anatomy of the pudendal nerve and its terminal branches: a cadaver study.

BACKGROUND: This study documents the anatomy of the pudendal nerve, which has a major role in maintaining faecal continence. Unexpected faecal incontinence can develop following perineal surgery even when the anal sphincters are not damaged. In addition, injury to the pudendal nerve might be encountered during pelvic procedures such as a sacrospinous colpopexy. METHODS: An anatomical study on 28 cadavers was conducted to examine the course of the pudendal nerve and its branches in the perineum. RESULTS: In five of the 28 cadavers dissected (four male, one female), a nerve plexus was found within the ischiorectal fossa in close proximity to the anal sphincters. The plexus received contributions from interconnecting branches of the inferior rectal and perineal nerves to innervate the external anal sphincter. In 11 of the 28 cadavers (five female, six male) an additional nerve arose from the medial aspect of the pudendal nerve at the level of the sacrotuberous and sacrospinous ligaments. This nerve continued distally and gave several branches to the perineum and the levator ani muscle. CONCLUSION: A sound knowledge of the anatomical variations of the pudendal nerve and its branches is essential for all surgeons operating in the perineal region.

Aged↗
PubMed2002

Decellularized cadaver vein allografts used for hemodialysis access do not cause allosensitization or preclude kidney transplantation.

BACKGROUND: Dimethyl sulfoxide-cryopreserved (CRY) cadaver vein allografts used for hemodialysis access in patients with renal failure recently have been shown to cause broad recipient allosensitization, measured by panel reactive antibody (PRA) assay. Synergraft (SYN) processing is a novel method of treating tissue that decellularizes the graft (including mismatched major histocompatibility antigens) and potentially should prevent allosensitization. METHODS: Twenty hemodialysis patients underwent placement of an SYN-processed cadaver vein allograft. PRA assay was used prospectively to assess allosensitization in these patients at baseline and 1-month intervals after engraftment. These results were compared with our historic series of CRY allograft recipients. RESULTS: There was no significant difference in baseline PRA values for SYN and CRY patients (2.8% versus 2.6%, respectively). None of the SYN patients became allosensitized at 3 months postengraftment (mean PRA, 3.2%), whereas all CRY recipients became highly sensitized at a mean of 3.1 months (mean PRA, 84.1%). This result was highly significant (P < 0.0001). CONCLUSION: SYN processing of cadaver vein allografts successfully removes antigenic material. The use of SYN allografts in patients with renal failure for hemodialysis access does not cause allosensitization and therefore should not preclude kidney transplantation.

Adult↗