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At least 289 records · Page 16Linked to original sources
PubMed2002

Interindividual reproducibility in perioperative rotational alignment of femoral components in knee prosthetic surgery using the transepicondylar axis.

Femoral component malalignment is one of the main causes of persisting anterior knee pain after knee replacement. This study examined interindividual reproducibility in perioperative definition of the transepicondylar axis (TEA) as a reference for measuring the rotational alignment of the femoral component. Eight surgeons experienced in knee prosthetic surgery marked on Thiel-embalmed cadaver specimens the reference points that they would normally use to define the TEA during knee replacement. These were digitized by a video system, and all the spots defined by the surgeon were translated into a reference picture, allowing a digital analysis of the distances between all the spots marked. The maximal distance between the spots that the participants had marked as relevant for the TEA was 13.8 mm at the lateral and 22.3 mm at the medial epicondyle. Projecting all spots marked into one picture resulted in an area of 116 mm2 on the lateral and 102 mm2 on the medial epicondyle. The median range of the fault between two different participants was 6.4 mm on the lateral side (range 13.2 mm) and 9.7 mm on the medial (range 21.6 mm). Because the rotational alignment of the femoral component is extremely relevant for successful implantation of total knee prosthesis, the interindividual discrepancy in defining the TEA as reference is rather high. As this reference line is commonly used, the perioperative variance and the resulting rotational discrepancy of the femoral component must be considered.

Arthroplasty, Replacement, Knee↗
PubMed2003

The cartilaginous and osseous geometry of the femoral trochlear groove.

Photography was used to study the geometry of the cartilaginous and osseous contours of the distal femur and the orientation of the trochlear groove in 9 fresh-frozen and 24 embalmed knees. The sulcus angle (146.1 degrees +/-5.5 degrees ) decreased from 0 degrees to 50 degrees of femoral flexion then increased afterwards. The maximum slope of the lateral femoral condyle (20.2 degrees +/-5.2 degrees ) also decreased with flexion. Both the sulcus angle ( p=0.0007) and maximum slope ( p=0.0001) were larger at 0 degrees than they were for 60 degrees cartilaginous surfaces. The lateral femoral condylar height decreased, whilst the medial femoral condylar height increased as the flexion increased. The femoral groove was midway between the two femoral epicondyles (49.5+/-3.9%), but deviated laterally as the flexion angle increased. The groove axis deviated distally and laterally from the femoral anatomical axis for both cartilaginous and bony surfaces, and the angle between the groove and anatomical axes was similar for both cartilaginous (19.1 degrees ) and osseous (16.8 degrees ) surfaces. Articular cartilage is not well represented on radiography yet it had a significant effect on the distal femoral geometry, and should be taken into account when evaluating the patellofemoral joint.

Aged↗
PubMed2004

Indication, surgical technique and results of endoscopic fascial release in plantar fasciitis (E FRPF).

The purpose of the present study is to present the surgical technique for, and review our indications and results after, endoscopic fascial release in patients with plantar fasciitis. In five thiel-embalmed human specimens, a biportal technique for endoscopic release of the plantar fascia was established. The aim was here to evaluate the relation between the plantar fascia and the heel spur and to perform a release that would not exceed 50-70% of the diameter of the calcaneoplantar fascia. The endoscopic technique was performed within the last 5 years in ten male and seven female patients. All patients with the clinical entity of plantar fasciitis underwent conservative treatment for at least 6 months. The average age at surgery was 35 years (24-56 years). In the first five patients, surgery was performed under c-arm control. In all patients the operation could be finished endoscopically. The endoscopic portals healed without complications. The time for surgery during the learning curve ranged between 21 and 74 min (average 41 min) and was still longer compared to the open technique. The clinical follow-up ranged between 4 and 48 months (average 18.5 months). Out of 17 patients, 13 improved clinically, and they would choose the treatment option again. In the Ogilvie-Harris score, seven patients showed good and six excellent results. In two patients, the initial results were not satisfactory, because of a bony stress reaction of the calcaneus. This complication was treated by 6 weeks of partial weight bearing, without any further problems. Two other patients developed secondary pain in the lateral column. In spite of the minimal invasive approach it seems to be important to be careful in increasing the weight bearing in early rehabilitation. The technique of the endoscopic plantar fascia release (E FRPF) can be performed in a standardised and reproducible procedure. The follow-up examination showed good midterm results, but a loss of stability of the plantar arch has to be strictly avoided.

Adult↗
PubMed2005

The infrapatellar fat pad: anatomy and clinical correlations.

This study examined the anatomy of the infrapatellar fat pad (IFP) in relation to knee pathology and surgical approaches. Eight embalmed knees were dissected via semicircular parapatellar incisions and each IFP was examined. Their volume, shape and constituent features were recorded. They were found in all knees and were constant in shape, consisting of a central body with medial and lateral extensions. The ligamentum mucosum was found inferior to the central body in all eight knees, while a fat tag was located superior to the central body in seven cases. Two clefts were consistently found on the posterior aspect of the IFP, a horizontal cleft below the ligamentum mucosum in six knees and a vertical cleft above, in seven cases. Our study found that the IFP is a constant structure in the knee joint, which may play a number of roles in knee joint function and pathology. Its significance in knee surgery is discussed.

Adipose Tissue↗
PubMed2003

The anatomy of midurethral slings and dynamics of neurovascular injury.

The aim of this study was to investigate the course of midurethral slings using tension-free vaginal tape. The TVT procedure was performed on six fresh pelves, measurements were obtained, and the structures were cross-referenced in 16 embalmed pelves. The midurethral sling enters the suburethral tissue 2.2-3 cm caudad to the internal urethral meatus, pierces the paraurethral musculature and vascular plexus, and exits 2+/-0.5 cm from the midline lateral to the point of insertion of the arcus tendineus fasciae pelvis. On the pubic tubercle the sling is 4+/-0.5 cm, 4+/-1 cm and 6+/-1 cm from the accessory obturator, the inferior epigastric and the external iliac vessels, respectively. The critical angle of error resulting in the external iliac vessel injury is 7-15 degrees. A current knowledge of pelvic anatomy may help the surgeon avoid the neural and vascular structures that are in the path of the sling.

Blood Vessels↗
PubMed2005

Anatomical study of the obturator foramen and dorsal nerve of the clitoris and their relationship to minimally invasive slings.

OBJECTIVES: The objective of the study is to clarify potential risks to the dorsal nerve of the clitoris (DNC) and obturator canal using different minimally invasive slings. STUDY DESIGN: Ten embalmed hemipelves were dissected to demonstrate the course of the DNC and the obturator canal. On each cadaver, tension-free vaginal tape (TVT), transobturator in-out (TVT-O) and transobturator out-in (Monarc) procedures were performed. Distances between the DNC and the obturator canal to the different devices were measured. RESULTS: The DNC passes beneath the pubic bone at a distance of 14.3 +/- 4.7 mm of the midline. The distances of the different devices to the DNC were similar. The distance to the obturator canal was significantly different, with TVT being the furthest (40.1 +/- 3.7 mm) and TVT-O the closest (19.3 +/- 3.1 mm; p < 0.0001). CONCLUSION: Given the course of the DNC along the medial aspect of the ischiopubic ramus, the out-in technique may be safer. The in-out technique is the closest to the obturator canal.

Cadaver↗
PubMed2006

Relationship of the uterosacral ligament to the sacral plexus and to the pudendal nerve.

We describe the anatomy of the uterosacral ligament with respect to the sacral plexus. In six adult female embalmed cadavers, we identified the uterosacral ligament and its lateral nerve relations. Using the ischial spine as the starting point and measuring along the axis of the uterosacral ligament, we noted that the S1 trunk of the sacral plexus passes under the ligament 3.9 cm [95% confidence interval (CI), 2.1-5.8 cm] superior to the ischial spine. The S2 trunk passes under the ligament at 2.6 cm (95% CI; 1.5, 3.6 cm), the S3 trunk passes under the ligament at 1.5 cm (95% CI; 0.7, 2.4 cm), and the S4 trunk passes under the ligament at 0.9 cm (95% CI; 0.3, 1.5 cm) superior to the ischial spine. The pudendal nerve forms lateral to the uterosacral ligament. Our data demonstrate that the S1-S4 trunks of the sacral plexus, not the pudendal nerve, are vulnerable to injury during uterosacral ligament suspension.

Female↗
PubMed1999

Activity of O6-methylguanine DNA methyltransferase in mononuclear blood cells of formaldehyde-exposed medical students.

A recent study reported that exposure of student embalmers in Cincinnati to high concentrations of formaldehyde (2 mg/m3) reduced the activity of the DNA repair protein O6-methylguanine DNA methyltransferase (MGMT). Reduction in a DNA repair enzyme may strongly increase the cancer risk not only with respect to the repair-enzyme causing agent but with respect to all carcinogens causing lesions subject to repair by the enzyme in question. Thus, we examined whether formaldehyde exposure of 57 medical students during their anatomy course at two different Universities in Germany influenced MGMT activity in mononuclear blood cells. Mean formaldehyde exposure of 41 students was 0.2 +/- 0.05 mg/m3 for 6 h per week. MGMT activity was 133.2 +/- 14.9 fmol MGMT/10(6) cells before the beginning of the formaldehyde exposure, 131.1 +/- 15.8 fmol MGMT/10(6) cells after 50 days (P = 0.56) and 128.2 +/- 19.0 fmol MGMT/10(6) cells after 111 days of exposure (P = 0.92). Similarly, no significant influence of formaldehyde exposure was observed, when smoking habits, alcohol consumption, allergic disease and sex of students were considered. In addition no significant difference was obtained in MGMT activity between 16 students with mean formaldehyde exposure of 0.8 +/- 0.6 mg/m3 and students without formaldehyde exposure (n = 51; P = 0.37). In conclusion, exposure of the medical students in western Europe to formaldehyde did not decrease MGMT activity in mononuclear blood cells.

Adult↗
PubMed2003

Architectural measures of the cancellous bone of the mandibular condyle identified by principal components analysis.

As several morphological parameters of cancellous bone express more or less the same architectural measure, we applied principal components analysis to group these measures and correlated these to the mechanical properties. Cylindrical specimens (n = 24) were obtained in different orientations from embalmed mandibular condyles; the angle of the first principal direction and the axis of the specimen, expressing the orientation of the trabeculae, ranged from 10 degrees to 87 degrees. Morphological parameters were determined by a method based on Archimedes' principle and by micro-CT scanning, and the mechanical properties were obtained by mechanical testing. The principal components analysis was used to obtain a set of independent components to describe the morphology. This set was entered into linear regression analyses for explaining the variance in mechanical properties. The principal components analysis revealed four components: amount of bone, number of trabeculae, trabecular orientation, and miscellaneous. They accounted for about 90% of the variance in the morphological variables. The component loadings indicated that a higher amount of bone was primarily associated with more plate-like trabeculae, and not with more or thicker trabeculae. The trabecular orientation was most determinative (about 50%) in explaining stiffness, strength, and failure energy. The amount of bone was second most determinative and increased the explained variance to about 72%. These results suggest that trabecular orientation and amount of bone are important in explaining the anisotropic mechanical properties of the cancellous bone of the mandibular condyle.

Biomechanical Phenomena↗
PubMed1999

Determination of calcaneal ultrasound properties ex situ: reproducibility, effects of storage, formalin fixation, maceration, and changes in anatomic measurement site.

The objective of this study was to determine the reproducibility of ultrasonic bone properties with a system for measuring calcanei ex situ; the influence of changes of the measurement site; and the effects of fixation, storage, and maceration. We examined 14 fixed calcanei and 12 fresh bones. Ultrasonic measurements were performed ex situ after degassing, using an Achilles+ system and a special positioning device. The instrument precision was 0.16% for speed of sound (SOS), 1.4% for broadband ultrasonic attenuation (BUA), and 1. 8% for the stiffness index (SI). The short-term precision was 0.54%, 1.9%, and 2.8%, respectively. A defined shift of the measurement site (5 mm distal of the middle) led to unpredictable changes in ultrasound (US) properties (r = 0.65 for SOS, 0.82 for BUA, and 0.75 for SI). Embalment with 4% formalin/96% alcohol caused a systematic decrease in SOS, an increase in BUA, and a decrease in SI (mean = -12.7 units; P < 0.001), the effect increasing with time. However, values at 6 months of fixation and later were highly correlated with those in fresh specimens (r = 0.95 for the SI). Two weeks storage in degassed and normal solution had only modest effects on ultrasound properties. Maceration did not lead to a systematic increase or decrease of ultrasound variables, but introduced unpredictable changes (r = 0.64-0.94). We conclude that in comparative biomechanical studies it is feasible to measure calcaneal specimens embalmed in formalin/alcohol ex situ, if the primary interest is not in the absolute values but in the correlation with mechanical failure loads at other skeletal sites.

Aged↗
PubMed2006

Fractures of the proximal femur: correlates of radiological evidence of osteoporosis.

OBJECTIVE: Fractures of the proximal femur are common sequelae of osteoporosis, and are responsible for significant morbidity and mortality in elderly patients worldwide. Plain film radiographic assessment methods to assess for fracture risk may be of particular value. DESIGN AND PATIENTS: The authors present the results of biomechanical testing, radiographic imaging, and histologic exam of 20 embalmed human bone specimens, with implications for clinical correlation of radiologic findings. Authors assessed bone architecture using the Singh Index, using a blinded 3-rater system to reduce bias and measure intra-observer reliability. After loading to failure with ultimate tensile strength (UTS), bone specimens were assessed by fracture location type and by trabecular bone volume (TBV). RESULTS: Singh scoring was performed with Inter-Class Correlation of 0.80 (F=0.24, by ICC Portney Model 2). A statistically-significant difference among the UTS distributions was noted for UTS by Fracture Site (F=4.49, p=0.026, by ANOVA). No significant association of Singh Index with TBV, or TBV with UTS, was observed, although a trend toward greater UTS with higher Singh grade was observed. CONCLUSIONS: The authors propose that the Singh Index is a valuable and reliable indicator which may reflect structural integrity in trabecular bone. Fracture site along the femur is associated with tensile strength. The authors, in the light of these findings, address the promise and potential impact of prophylactic hip augmentation in populations at risk for femoral neck pathology.

Aged↗
PubMed2007

Nerve-identifying inguinal hernia repair: a surgical anatomical study.

BACKGROUND: Pain syndromes of somatic and neuropathic origin are considered to be the main causes of chronic pain after open inguinal hernia repair. Nerve-identification during open hernia repair is suggested to be associated with less postoperative chronic pain. The aim of this study was to define clinically relevant surgical anatomical zones facilitating efficient identification of the three inguinal nerves during open herniorrhaphy. METHOD: Through dissection of 18 inguinal areas of embalmed and unembalmed human cadavers, identification zones were developed for the inguinal nerves (in particular for the genital branch of the genitofemoral nerve). RESULTS: The iliohypogastric nerve was identifiable running approximately horizontally and ventrally to the internal oblique muscle perforating the external oblique aponeurosis at a mean of 3.8 cm (range 2.5-5.5 cm) cranially from the external ring. When present, the ilioinguinal nerve was identifiable running ventrally and parallel to the spermatic cord, dorsally from the aponeurosis of the external oblique muscle. Identification of the genital branch of the genitofemoral nerve was more comprehensive. The course of the genital branch is laterocaudal at the level of the internal inguinal ring. CONCLUSION: Based on the newly defined identification zones, peroperative identification of all inguinal nerves is possible. Further research is warranted to assess clinical feasibility of these zones and to evaluate the influence of (facultative) division, preservation or omittance of the identification of inguinal nerves on the incidence of chronic pain.

Cadaver↗
PubMed2000

The fetal gallbladder: morphology and morphometry by microdissection.

Most studies of the fetal gallbladder have been performed using ultrasonography. The identification of the fetal gallbladder and the presence of gallstones have been determined this way. The purpose of this study was to investigate the morphology and morphometry of the actual fetal gallbladder by microdissection and to examine its internal features and content. Eighty-nine formalin-embalmed fetuses of CR age 35 mm to 342 mm, i.e. 10 weeks to 36 weeks gestational age (GA), were studied by hepatic evisceration. The fetal gallbladder was examined in-situ in its bed, in relation to the umbilical vein, the anterior hepatic margin and its protrusion below the inferior hepatic surface of the liver. After excision, the form, length and diameters of the gallbladder were determined and its internal surface, lumen and content also examined. The mean length of the fetal gallbladder for the gestational ages studied ranged from 2.21 mm (10 weeks GA) to 281.6 mm (32 weeks GA); the mean fundal diameter ranged from 0.4 mm (one specimen only) to 9.42.4 mm for the same period, while the infundibular width ranged from 0.41 mm (one specimen only) to 9.01.6 mm, and the antero-posterior diameter at the fundus ranged from 0.90.3 mm to 9.03.3 mm for the same period. The parameters of the gallbladder for the period examined showed a curvilinear increase in size and were consistent with the ultrasonographic studies. The distance of the fetal gallbladder from the umbilical vein was variable and, as the gallbladder lengthened, the fundus encroached the anterior hepatic margin towards 34 weeks. A descent of the gallbladder from an "intra-hepatic" position early in fetal life to a sub-hepatic position later was clearly evident. The gallbladder wall was thick in early fetal life (10-13 weeks GA) and contained crumbly debris. Bile staining occurred at 14 weeks gestational age and the mucosa took on the normal appearance with the bile having an adult colour and consistency at 20 weeks GA.

Dissection↗
PubMed2001

Anatomy and function of the subdeltoid bursa.

An anatomical study was undertaken on 40 non-embalmed normal cadaver shoulders to determine the attachments, boundaries and macroscopic nerve supply of the subdeltoid bursa. Two areas of attachment were observed, one (proximal and superficial) along the free border of the coracoacromial ligament and adjacent deep surface of deltoid, the other (distal and deep) to the humerus distal to the supraspinatus tendon: there were no posterior or anterior attachments. In addition, two blind pouches were observed, one proximal under the coracoacromial ligament and the other beyond the distal attachment. The continuity observed between the lateral border of the coracoacromial ligament and the subdeltoid bursa provides a smooth surface, thereby casting doubt on the aggressive action of the ligament on the rotator cuff.

Aged↗
PubMed2001

A case with multiple anomalies in the upper limb.

During routine educational dissection studies, we encountered multiple nervous and arterial anomalies in a 60-year-old embalmed male cadaver. The arterial anomalies were observed on the right side. The superficial brachial artery originated from the axillary artery under the pectoralis minor muscle. There was an arch between the superficial brachial and brachial arteries in the cubital fossa. Additionally, a communication was observed between the musculocutaneous and median nerves. Moreover, the coracobrachialis muscle was innervated by an accessory nerve branch originating from the lateral cord of the brachial plexus. All of the nervous anomalies were on the left side. A combination of these variations in the same case has not, to our knowledge, been previously described in the available literature.

Abnormalities, Multiple↗
PubMed2001

The pectineal ligament: anatomical study and surgical applications.

The aim of this study was to reinforce the importance of the pectineal ligament in laparoscopic surgery for groin hernia and female urinary incontinence, particularly its anatomical importance in the myopectineal region. A morphologic study was conducted on 44 pectineal ligaments from 23 embalmed and one fresh human cadavers, together with a radiological study on four volunteer patients. Anatomical and histological findings confirm the fact that the ligament of Cooper represents a thickening of the pectineal fascia rather than a thickening from the periosteum. The pectineal ligament provides a landmark in each approach, open or laparoscopic, anterior or posterior surgery.

Aged↗
PubMed2001

Intrathoracic blood supply of the left vagus and recurrent laryngeal nerves.

The arteries and veins of the left vagus (VN) and left recurrent laryngeal (RLN) nerves from the thoracic inlet to the subaortic region are described following vascular casting with red colored latex in 6 adult fresh non-embalmed cadavers. In all specimens the anterior bronchoesophageal artery supplied at least one vessel to the VN and RLN in the subaortic region. For the RLN other arterial sources were arteries arising from the aortic arch in 1 specimen, the subclavian artery in 3 specimens, the first intercostal artery in 1 specimen, and the inferior thyroid artery in all specimens. For the VN other arterial sources were arteries arising from the aortic arch in 2 specimens and the inferior thyroid artery in 1 specimen. For both the VN and RLN the veins were located under the pleura and directed towards the internal thoracic vein anteriorly and the thoracic intercostal veins posteriorly. In conclusion, the inferior thyroid artery at the thoracic inlet for the RLN and the anterior bronchoesophageal artery are the more consistent vessels supplying the VN and RLN. Vascular damage occurring during mediastinal lymph node excision to the VN and RLN, especially in the subaortic region, may explain postoperative vocal fold paralysis.

Adult↗
PubMed2001

Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomical basis of anterior snapping of the hip.

Anterior hip snapping is a rare clinical observation. The physiopathological hypothesis currently held is a sudden slip of the iliopsoas tendon over the iliopectineal eminence. For symptomatic cases, a surgical technique is proposed. The aim of this work is to describe the anatomy of the femoral portion of the iliopsoas, which is the target of surgery. We have studied, through dissection of embalmed cadavers, the different components of the musculotendinous complex forming the femoral portion of the muscle and the gliding apparatus associated with it. The psoas major tendon exhibited a characteristic rotation. The iliacus tendon, more lateral, received the most medial iliacus muscular fibers, then fused with the main tendon. The most lateral fibers, starting in particular from the ventral portion of the iliac crest, ended up without any tendon on the anterior surface of the lesser trochanter and in the infratrochanteric region. The most inferior muscular fibers of the iliacus, starting from the arcuate line, joined the principal tendon of the psoas major passing around it by its ventromedial surface. An ilio-infratrochanteric muscular bundle was observed, in a deeper position, under the iliopsoas tendon; it arose from the interspinous incisure and on the anterior inferior iliac spine, ran along the anterolateral edge of the iliacus and inserted without any tendon onto the anterior surface of the lesser trochanter of the femur and in the infratrochanteric area. The iliopectineal bursa was studied on horizontal cross sections of a frozen pelvis and on 5 of the non-frozen preparations after dividing the iliopsoas tendon. The iliopectineal bursa had the shape of a 5 to 6-cm high and 3-cm wide cavity; in its upper part, it was divided into 2 compartments: a medial compartment for the main tendon and a lateral compartment for the accessory tendon.

Female↗