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At least 271 records · Page 15Linked to original sources
PubMed1999

Pressures exerted against the cervical vertebrae by the standard and intubating laryngeal mask airways: a randomized, controlled, cross-over study in fresh cadavers.

UNLABELLED: In this randomized, controlled, cross-over study, we measured the pressures exerted by the standard laryngeal mask airway (LMA) and the intubating laryngeal mask airway (ILM) against the cervical vertebrae during insertion, intubation, and maneuvers commonly used to facilitate intubation. We also assessed the effect of these pressures on cervical spine (C-spine) movement. Twenty cadavers (6-24 h postmortem) without cervical abnormality were initially studied. Three microchip pressure sensors were implanted into the pharyngeal surface of C2-3. The size 5 ILM and LMA were inserted in random order into each cadaver with the head-neck in the neutral position. Maximal cervical pressures (CPmax) were recorded for both devices during cuff inflation from 0-40 mL and with the intracuff pressure (ICP) at 60 cm H2O, insertion, fiberscope-guided intubation, partial withdrawal/reinsertion (ILM only), elevation/depression of the handle with 20 N of force applied (ILM only). In five additional matched cadavers, the effect of pressure on posterior displacement of C3 was assessed, and CPmax was measured during laryngoscope- and fiberscope-guided oro/nasotracheal intubation (controls). CPmax was higher for the ILM than the LMA over the inflation range (96 vs 15 cm H2O; P < 0.0001) and with the ICP at 60 cm H2O (95 vs 10 cm H2O; P < 0.0001). During cuff inflation, CPmax was generally unchanged for the ILM but was always increased for the LMA. CPmax for the LMA and ILM was similar during insertion (224 vs 273 cm H2O) but higher for the ILM during fiberscope-guided intubation (96 vs 43 cm H2O; P < 0.0001). At 60 cm H2O ICP, CPmax increased during LMA (224 cm H2O; P < 0.0001) and ILM insertion (273 cm H2O; P < 0.0001) and increased for the LMA (43 cm H2O; P < 0.0001) but was unchanged for the ILM (96 cm H2O) during fiberscope-guided intubation. For the ILM, CP-max increased during handle depression (394 cm H2O; P < 0.0001) and partial withdrawal/reinsertion (265 cm H2O; P < 0.0001) but decreased during handle elevation (6 cm H2O; P < 0.00001). CPmax for the controls was usually zero and was always less than the LMA/ ILM (P < 0.0001). The mean (range) for posterior displacement of C3 was 0.8 (0-2) mm at 100 cm H2O and 2.8 (1-5) mm at 400 cm H2O. Laryngeal mask devices exert greater pressures against the cervical vertebrae than established intubation techniques and can produce posterior displacement of the C-spine. IMPLICATIONS: Laryngeal mask devices exert greater pressures against the cervical vertebrae than established intubation techniques and can produce posterior displacement of the cervical spine. We recommend that laryngeal mask devices only be used in the unstable cervical spine if difficulties are anticipated or encountered with established techniques, pending the results of studies demonstrating its relative safety.

Aged↗
PubMedDate not supplied

[Impact of transplantectomy of the first graft on the clinical course of cadaver renal retransplantation].

PURPOSE: At the present time a number of prediction factors on the outcome of second cadaver renal transplants are known, in particular the influence of recipient response to the first graft. However, we do not know if retaining or removing the non-functioning organ has any repercussion on subsequent transplants. This is the object of the present study. MATERIAL AND METHODS: A retrospective study was carried out on the clinical records of 80 patients who had undergone a second cadaver renal transplant under CyA between 1985-1995 at Hospital 12 de Octubre. Data on the characteristics and outcome of the first and second transplants were collected, plus those concerning the recipient and donor. These variables were used to construct a multivariant analysis model of graft survival. The nephrectomy of the non-functioning graft was only carried out when absolutely necessary (n = 58). RESULTS: The multivariant analysis showed that the nephrectomy of the non functioning graft did not modify the risk of recipient sensitization or the probability of developing acute or chronic rejection of the second graft. However, it reduced the risk of losing this second graft at medium or long term significantly (p = 0.009). CONCLUSIONS: These data constitute the first solid argument in favor of elective nephrectomy in candidates for a second cadaver renal transplant. Nevertheless, a more thorough study should be carried out of the immunological mechanism involved before recommending this as a general procedure.

Adult↗
PubMedDate not supplied

[HLA compatibility and antigenic re-exposure. Impact on the clinical course of cadaver kidney transplantation].

OBJECTIVES: A number of prediction factors on the outcome of cadaver renal transplants have been recognized, particularly the influence of recipient response to the first graft. However, the influence of HLA compatibility and of repeated recipient and donor antigen mismatches remain a controversy. The importance of the foregoing on the survival of the second renal graft is analyzed in this study. METHODS: The clinical records of 80 patients who had undergone a second cadaver renal transplantation from 1985 to 1995 at the Hospital 12 de Octubre (Madrid, Spain) were reviewed. Data on the recipient, donor and graft characteristics and outcome of the first and second transplants were collected for multivariate analysis of graft survival using the Cox regression method. The importance of the overall HLA compatibility and of each HLA locus, and the effect of antigenic re-exposure on the survival of the second renal graft were analyzed. RESULTS: The multivariate analysis showed a significant increase of the survival of the second graft when there were at least three compatible antigens between donor and recipient (p = 0.02). Compatibility of the HLA-A and DR loci appeared to improve the outcome, although the differences were not statistically significant. However, a significant improvement in the survival of the second cadaver renal allograft was found for repeated HLA mismatches between the recipient and donors (p = 0.006). CONCLUSIONS: Our data corroborate the benefits of assigning renal grafts according to the degree of HLA compatibility also for the second renal transplant. Furthermore, our data show that re-exposure to previous mismatched antigens need not be hazardous for the second renal transplant in the cyclosporine era.

Adult↗
PubMed1975

Cadaver donor nephrectomy.

Optimal preservation of renal and ureteral structure and function is attempted by maintenance of renal circulation during heart-beating cadaver nephrectomy. Modifications of Ackermann's en bloc procedure for removal of cadaver kidneys are suggested to adapt this procedure to the heart-beating cadaver situation.

Cadaver↗
PubMed1999

The LifeLink Foundation and cadaver kidney transplantation in Tampa.

1. LifeLink Foundation, a not-for-profit organization, has been the driving force and absolutely essential entity for kidney and liver transplantation in Tampa providing all the components (patient, organs and clinicians) save for inpatient hospitalization. It also plays a big role in the heart transplant program. LifeLink has increased the kidney transplant rate from the first 1,000 done in 17 years to the second 1,000 in 7 years and is on a pace for the third 1,000 in 5 1/2 years. 2. Because of its innovative programs, cadaver donor procurement by the Tampa LifeLink OPO has been roughly double the national average for the past 10 years. Because of cadaver kidney availability the median wait time from activation on the wait list to transplantation over the past 5 years was 159 days. The recent transplant rate is 14.7-22.7% higher than the national average, dependent upon the parameter measured. Similar results are seen for Tampa patients awaiting heart and liver transplantation. 3. The overall outcome of 1,184 cadaver kidney transplants performed in the decade 1989-98 was similar to that reported from the UNOS database in this series of publications. a) One- and 2-year graft survival increased 2% per year over the decade with a recent one-year graft survival rate of 96%. The overall T1/2 was 10 years. b) Our disastrous 1994 results were quickly reversed by a more intense pretransplant medical evaluation, the introduction of mycophenolate mofetil, more aggressive and earlier treatment of rejection episodes, and mandatory T- and B-cell flow cytometry crossmatching for all transplants. The incidence of rejection episodes decreased from 40 to 20%, and the first year immunological graft loss decreased from 5%, to 1.9%, to 0.8%, to 1.4% and 0% over the succeeding 4 years. 4. Individual factors affecting allograft survival were strikingly similar to national data, although all did not react statistical significance probably due to the smaller numbers. a) Primary and second grafts had similar survival rates (p = 0.97) whereas the third or subsequent graft survival was 7-32% poorer (p = 0.02). b) Black recipients had survival rates 10-13% lower than Caucasians and other races (p = 0.003). c) Patients with a peak PRA > 50 had survival values 4-13% poorer than those with < 50 PRA (p = 0.14). d) Patients with 2-4 HLA mismatches had graft survival rates 4-10% poorer than those with 0-1 mismatch (p = 0.12), whereas those with 5-6 mismatches had rates 6-17% poorer (p = 0.04). e) Although 22% of our transplants were to patients > 60 years of age, there was no difference (p = 0.81 to 0.90) in graft survival for the age groups 0-40, 41-60 and > 61. However, the proportion of grafts lost due to patient death compared with all allografts lost, was very different at 21% in the youngest group, 43% in those 41-60 years of age, and 63% in recipients > 61 years. 5. The rate of delayed graft function with imported kidneys was higher (27 vs. 16%, p = 0.006) but essentially the same as local kidneys with the same ischemia times. However, 41% of local kidneys were transplanted within 12 hours of procurement. Totally, 78% of local kidneys were transplanted within 18 hours (11% DGF rate) versus 79% of imports being transplanted at > 18 hours (32% DGF rate). Ischemia time, not the kidney source is the key issue since: a) There was no difference in overall graft survival of imported versus local kidneys (p = 0.95) nor in comparing local versus import kidneys with (p = 0.66) or without (p = 0.69) DGF. b) There was, however, a 11-17% overall poorer graft survival over 3 years in kidneys with DGF (p < 0.001) seen with both local (9-18% poorer, p = 0.0002) and imported (12-19% poorer, p = 0.008) kidneys. c) Kidneys displaying DGF came from older donors (40 vs. 34 years, p = 0.023) and had longer ischemia times (21 vs. 15 hours, p < 0.0005). 6. Dual kidney transplants were started in late 1996 with older or marginal donors to provide a better chance of success fo

Adolescent↗
PubMed2000

Comparison of skin permeability of drugs in mice and human cadaver skin.

In vitro percutaneous absorption of four antihypertensive drugs were carried out across the mice and human cavader skin in order to compare their skin permeability. An interesting trend was noticed in these experiments. Poorly water soluble drug prazosin hydrochloride showed 13 times enhanced flux in the mice skin whereas the steady-state flux of the water soluble drug propranolol hydrochloride was almost same in both human cadaver and mice skin. The permeation rate of prazosin hydrochloride and propranolol hydrochloride through the human cadaver skin fluctuated widely over time, but in mice skin, distinct trends were noticed. The study indicates that the overall permeation rate in mice skin is higher than that in the cadaver skin and the meeting of the target-flux in mice skin does not guarantee its good permeability in human skin.

Administration, Cutaneous↗
PubMed2001

Comparison of biomechanical head-neck responses of hybrid III dummy and whole body cadaver during inverted drops.

The anthropometric hybrid III dummy test device is the most widely used physical model to assess the injury severity during automotive crashes. The dummy was designed to replicate the human neck in flexion and frontal impacts. Various investigators have compared the dummy neck with living human and cadaveric responses in frontal impacts. However, the comparison between the whole body human cadaver and dummy under an inverted drop is currently lacking. This study was designed to review the exiting data and obtain the comparative data between the human cadaver and the dummy. The vertical whole body cadaver drops from our laboratory and literature have been used. There exists a wide variation between the human and dummy neck responses. The dummy neck was approximately two to four times stiffer under axial compression in the quasi-static or in the dynamic mode. The present comparison will provide a basis to better design the anthropometric dummies in order to obtain an improved injury assessment during inverted drops.

Accidents, Traffic↗
PubMed2004

Efficacy of orthotic immobilization of the unstable subaxial cervical spine of the elderly patient: investigation in a cadaver model.

OBJECTIVE: To assess the efficacy of soft, semirigid and hard cervical collars to immobilize the neck in a destabilized cadaver model. DESIGN: This is a laboratory experiment. SETTING: The anatomy research lab of McMaster University. PATIENTS: None. Fresh cadavers from elderly patients suffering terminal medical illness and free of cervical structural disease were studied. INTERVENTIONS: Destabilizing discoligamentous lesions of the neck were created in the cadavers. Radiographs were taken in maximum displacement in the prone, decubitus and side-bending positions, first unsupported and then with soft, semirigid and hard collars applied. Displacements in angulation and translation were measured from the radiographs. OUTCOME MEASURES: Radiographic displacement under gravity load. RESULTS: In all cases there was no effective limitation of pathological displacement, and in many cases displacement was increased after collar application. CONCLUSIONS: Cervical collars do not effectively support the unstable neck, and may be ineffective in preventing pathological displacements.

Aged↗
PubMedDate not supplied

Permeation study of five formulations of alpha-tocopherol acetate through human cadaver skin.

Alpha-tocopherol (AT) is the vitamin E homologue with the highest in vivo biological activity. AT protects against the carcinogenic and mutagenic activity of ionizing radiation and chemical agents, and possibly against UV-induced cutaneous damage. For stability consideration, alpha-tocopherol is usually used as its prodrug ester, alpha-tocopherol acetate (ATA), which once absorbed into the skin is hydrolyzed to alpha-tocopherol, the active form. The objective of this research was to characterize in vitro the permeation properties of ATA from various solutions and gel formulations. Permeation studies were conducted using modified Franz diffusion cells and human cadaver skin as the membrane. Specifically, 5% (w/w) alpha-tocopherol acetate was formulated in the following vehicles: ethanol, isopropyl myristate, light mineral oil, 1% Klucel gel in ethanol, and 3% Klucel gel in ethanol (w/w). The receiver temperature was 37 degrees C. Samples from the receiver were collected at 2, 4, 6, 8, 12, 24, 30, 36, and 48 hours and analyzed by HPLC for concentrations of alpha-tocopherol acetate and alpha-tocopherol. The permeabilities of ATA through human cadaver skin were 1.0x10(-4), 1.1x10(-2), 1.4x10(-4), 2.1x10(-4), and 4.7x10(-4) cm/h for the ethanol solution, isopropyl myristate solution, light mineral oil solution, 1% Klucel gel, and 3% Klucel gel, respectively. The results show that the formulation had relatively minor effects on the permeability coefficients of ATA through cadaver skin in all cases except for the isopropyl myristate solution.

Analysis of Variance↗
PubMed2006

Measurement of the mechanical response of intra-abdominal organs of fresh human cadavers for use in surgical simulation.

Determination of soft tissue properties is essential for the realism of the virtual scenarios. The major challenge is that soft tissues exhibit complicated mechanical properties including viscoelastic, nonlinear, inhomogeneous, and rate dependent behaviors. Measurements on live human patients present significant risks, thus making the use of cadavers a logical alternative. Cadavers are widely used in present day surgical training, are relatively easy to procure through excellent donor programs and have the right anatomy, which makes them better candidates for training than the porcine model. To investigate the static and dynamic properties of soft tissue, we have developed a high precision tactile stimulator by modifying an existing haptic interface device, the Phantom, and used it to record the force-displacement behavior of intra-abdominal organs of fresh human cadavers at the US Surgical facility in Connecticut and Albany Medical College.

Abdomen↗
PubMed2006

Variations of the course of the upper trunk of the brachial plexus and their clinical significance for the thoracic outlet syndrome: a study on 93 cadavers.

The aim of this study is the recording of the variations of the course of the upper trunk (UT) of the brachial plexus (BP) and their clinical significance for the thoracic outlet syndrome (TOS) and the anesthetic blockade of the BP. Five different anatomical variations of the course of the UT of the BP, in relation to the anterior scalene muscle (ASM), were observed in 24 out of the 186 sides of the 93 cadavers we studied (12.9%). The C5 root was passing anteriorly to the ASM in six cases. The UT was located anteriorly to the ASM in four cases and was perforating the ASM's belly in 12 cases. In one cadaver, the ASM was double and the UT was passing between the two bellies of the double ASM. Finally, in another cadaver, the C5 root was found to be anterior to the anterior scalene muscle, while the C6 root was perforating the ASM's belly. These variations are predisposing factors for the TOS; they cause specific symptomatology and require a different surgical approach in comparison with other causes of the syndrome. Moreover, knowledge of these is important during the performance of the anesthetic blockade of the BP.

Adult↗
PubMed1991

The results of transplant livers from selected non-heart-beating cadaver donors.

The clinical experience following transplantation of livers obtained from non-heart-beating cadaver donors (NHBD) with the use of core cooling method is presented here. Six livers procured from such cadavers were transplanted into 6 recipients with hepatoma involving right and left lobes but without distant metastases. The first liver subjected to 75 minutes of warm ischemia had insufficient function after transplantation. The recipient died of graft failure 54 days later. The other 5 livers with 32 to 45 minutes of warm ischemia had a good or excellent immediate function. These 5 recipients died of tumor recurrence, acute rejection or septicemia 131 to 261 days after transplantation. The utilization of selected NHBD is suggested by our practice as a possible approach to help alleviate the acute organ shortage in the areas where heart-beating cadaver donors of brain death are not available.

Adult↗
PubMed2006

Inception of cadaver dissection and its relevance in present day scenario of medical education.

The concept of dissection for acquiring knowledge about the structure of human body was started in 15th century and barber--surgeons used to demonstrate various structures at the professors command. Andreas Vesalius (1514-1564) was the first medical student to dissect the cadaver and also continued with it even as a professor. Slowly and steadily its importance was realised. Once autopsy was accepted as a ideal parameter to establish the causes of death, the importance of dissection got enhanced. Cadavers were obtained earlier from the grave robbings and mortuaries, which was followed by, an Anatomy Act of 1832, by which unclaimed bodies were provided to the anatomy department. For last two decades, many persons started donating their bodies to the department of anatomy. In India, mostly unclaimed bodies are handed over to anatomy department for teaching and research purpose. Cadavers teach students during 1st professional course, autopsy teaches again in IInd and IIIrd professional courses and even later on throughout the career. Dissection helps in developing a spatial and tactile appreciation for the fabric of the human body that cannot be achieved by prosection or computerised learning aids alone.

Anatomy↗
PubMed1990

The effect of DR antigens, race, sex, and peak PRA on estimated median waiting time for a first cadaver kidney transplant.

1. Fifty-six DR phenotypes account for 95% of the population waiting for a transplant and who have received a transplant. There are 15 pairs that account for 46% of the population. Large differences in the distribution of DR phenotypes between the races were observed. 2. There do not appear to be significant differences among the 15 DR phenotypes in the rate of transplantation. There are, however, significant differences in the median waiting time to a first cadaver kidney transplant across the 15 DR phenotypes. 3. Blacks are not being transplanted in proportion to their numbers on the list of those awaiting a transplant. Blacks represent approximately 27% of the population waiting for a transplant, but represent only 22.6% of the population which receives a first cadaver kidney transplant. 4. The estimated median waiting time for Blacks is almost twice that of Whites. When age, peak PRA, DR phenotype, blood type, and sex are controlled, Blacks, when compared to Whites, are still 18% less likely to receive a first cadaver kidney transplant at any point in time.

Black People↗
PubMed1989

Sternocostal joints. Anatomic, radiographic and pathologic features in adult cadavers.

Using radiographic-pathologic correlation, we studied the sternocostal joints derived from 27 consecutive cadavers and one additional cadaver with rheumatoid arthritis. Radiographic findings that were tabulated included joint space narrowing, sternal or costal osteophytes, articular calcification, vacuum phenomena, and the degree of ossification of the costal cartilages. The first sternocostal joint could be classified as either a synchondrosis or synostosis in every instance; however, a joint cavity lateral to the first sternocostal joint represented a normal variation and was seen radiographically in 10 specimens. The second sternocostal joint was synovial in type and intimately related to the manubriosternal joint; cavitation within this joint was present bilaterally in 36% of our specimens. Degenerative changes in the sternocostal articulations were characterized much more frequently by sternal osteophytes than by costal osteophytes or joint space narrowing. Calcification compatible with chondrocalcinosis was observed in two cadavers. Radiographic and pathologic evidence of synovial inflammation was evident in the sternocostal joints of the rheumatoid specimen.

Aged↗
PubMed1978

[The selection and surveillance of cadaver kidney recipients. Recent development in graft immunology (author's transl)].

This study, based on results of 252 cadaver kidney transplantations, shows that some factors which reflect individual immune response capacity, such as ability to produce anti-HLA antibodies, sex and response to hepatitis B virus, appear, along with HLA compatibility, to markedly influence renal graft survival and leads us to propose the following new guide-line for cadaver kidney recipient selection: For "good responders" (i.e., patients with anti-HLA antibodies, females and HBs Ag negative individuals) a close HLA compatibility with the donor (3 or 4 antigens in common) is necessary, while this need not be observed for "non-responders" (i.e., patients without preformed anti-HLA antibodies, males and HBs Ag persistent carriers). Furthermore, review of recent methods proposed for detecting early cellular and humoral manifestations of rejection leads to proposal of the following immunological monitoring of the transplant recipient. Systematic and frequent testing for circulating cytotoxic cells and antibodies against donor antigens, regular dosage of complement factors and of the nephretic factor, and investigations for the migration leukocyte inhibiting factor and macrophage arming factor, possibly produced in vitro by lymphocytes. Both these protocols for recipient selection and immunological monitoring can henceforth be applied and may contribute to improve cadaver kidney transplantation prognosis.

Cadaver↗
PubMed1987

Reappraisal of the flap valve mechanism in the gastroesophageal junction. A study of a new valvuloplasty procedure in cadavers.

This study in cadavers was carried out to resolve whether a functional flap valve exists at the gastroesophageal (GE) junction and whether an accentuation of this valve (valvuloplasty) could increase the GE pressure gradient. Cadavers were investigated with open manometry catheters in the esophagus and stomach. Stepwise (50 ml) filling of the stomach demonstrated a GE pressure gradient of 4.6 +/- 1.6 cmH2O. This gradient could be significantly increased to 12.5 +/- 3.1 cmH2O (p less than 0.05) by performing a valvuloplasty procedure through a gastrostomy. By depressing the fundus of the stomach, the angle of His was made more obtuse and the flap valve component eliminated. This maneuver resulted in reflux in all cadavers before as well as after valvuloplasty. These experiments and observations taken together with our valvuloplasty procedure, confirm that a flap valve mechanism exists at the GE junction.

Adult↗
PubMed1979

A pilot program of multiple cadaver organ and tissue retrieval.

A one year pilot project conducted at a 2,000 bed medical center involved a unique approach to the retrieval from cadavers of multiple viable organs and tissues. Aspects of the program included a special unit for sterile evaluation and storage of tissue, a computerized registry of potential donors, a nurse to coordinate and expedite retrieval, and a retrospective chart review to define the incidence and location of potential cadaver donors. There were requests for 121 tissues by 39 investigators. Eleven different tissues were needed within 4 hours of death. Forty-two percent of individuals contacted directly enlisted in the donor registry, three of whom were identified on the computer at the time of death. A five-fold increase in cadaver donor evaluation referrals occurred, and one third of referrals resulted in viable tissue retrieval. A review of 728 deaths indicated that 45% could have been potential eye donors, 27% pancreas donors and 2.5% kidney donors. A coordinated program to retrieve multiple viable organs and tissues for transplantation and research appeared to be effective in this initial pilot study.

Cadaver↗