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At least 325 records · Page 18Linked to original sources
PubMed2006

Anatomical bases of prolonged ilio-inguinal-hypogastric regional anesthesia.

Although anesthesia and post-operative analgesia are associated with specific morbidity, regional anesthesia is not systematically given during groin hernia surgery. The goals of this work were to determine the anatomical bases of safe ilio-inguinal (II)-hypogastric anesthesia that can be prolonged into the post-operative period and to validate this technique on anatomical preparations and in clinical situations. We studied the courses of the ilio-hypogastric (IH) and II nerves in 33 halves of 20 embalmed adult cadavers. The intermediate portion of the IH and II nerves, located between the transverse and the internal oblique muscles, were found to be suitable for a simultaneous block with a single injection. We assessed the feasibility of injecting a percutaneous infiltration into this space by injecting a dye before dissection. In 75% of cases, we observed percutaneous coloring of the nerves, confirming that this site was suitable. To guide the infiltration, the points where the nerves passed through the transverse and the internal oblique muscles were located from the iliac crest and anterior and superior iliac spine, respectively. The nerve trunks were grouped for over 5 cm in a cell-fat layer running between these two deep muscles. It was possible to position a micro-catheter in this anatomical space to allow repeated injections. The results of this anatomical study were used to modify the technique so that it could be used to provide regional anesthesia in five patients operated on for hernia. Post-operative pain was very effectively controlled in four cases with no complications.

Adult↗
PubMed2006

The membranous layer of superficial fascia: evidence for its widespread distribution in the body.

A discrete membranous layer, "stratum membranosum", in human subcutaneous tissue is classically described as confined to the lower anterior abdominal wall and perineum and referred to as Scarpa's and Colles' fasciae, respectively. Evidence for its existence elsewhere in the body is scanty and therefore the present study was undertaken. Dissection of six embalmed adult cadavers, along with ultrasound imaging on four living subjects, were carried out to determine the existence, topography, and thickness of the membranous layer of superficial fascia in different regions of the body. In all six cadavers, a continuous layer of fibrous membrane in the superficial fascia was found consistently in all the dissected regions of the body and was also confirmed by ultrasonography. The arrangement and thickness of this membranous layer varied according to body region, body surface, and gender. It was thicker in the lower than in the upper extremity, on the posterior than anterior aspect of the body, and in females than in males. The mean thickness of the membranous layer ranged from 39 to 189 mum, being thickest in the leg and thinnest over the dorsum of the hand. The membranous layer was observed to have two or even three components in regions such as the breast, back, thigh, and arm and was seen to split, forming special compartments around subcutaneous major veins of upper and lower extremities, with fibrous septa extending to attach to the vessel wall. Functionally, the membranous superficial fascia may play a role in the integrity of the skin and support for subcutaneous structures particularly veins, by ensuring their patency. Understanding the topographic anatomy of this fascial layer may help explain body-contour deformities and provide the anatomic basis for surgical correction.

Abdominal Wall↗
PubMed2004

Biomechanical analysis and quantitative analysis of bone scintigraphy on thrust plate hip prosthesis.

INTRODUCTION: To study the load distribution of the thrust plate hip prosthesis (TPP, Sulzer Medica, Baar, Switzerland) on femoral bone, a TPP insertion group and intramedullary cemented stem insertion group were prepared with the use of embalmed femoral anatomic specimens, and strain on the femoral bone induced by loading was measured. MATERIALS AND METHODS: Bone scintigraphy was performed in 26 joints which underwent total hip arthroplasty with the use of TPP, to enable quantitative evaluation of postoperative remodeling of the bone. RESULTS: In the TPP insertion group, the strain was almost equivalent to that in the untreated femoral control group. On the other hand, compared with the control group and TPP insertion group, strain in the proximal portion of the femoral bone (medial side of the femoral neck) was significantly smaller in the cemented stem group (control group versus cemented stem insertion group, p=0.0062; cemented stem insertion group versus TPP 130 degrees insertion group, p=0.0005; cemented stem insertion group versus TPP 140 degrees insertion group, p=0.0031). Bone scintigrams revealed decreased uptake at 12 weeks after operation compared with 6 weeks after operation, indicating that TPP allows earlier implant stabilization than the conventional stem. CONCLUSION: Compared with the conventional stem, TPP is a prosthesis that can perform physiological load transmission.

Aged↗
PubMed2002

The preperitoneal tissue dilemma in totally extraperitoneal (TEP) laparoscopic hernia repair: an anatomo-surgical study.

BACKGROUND: One of the a main reasons for the long learning curve associated with totally extraperitoneal (TEP) laparoscopic hernia repair is an insufficient understanding of the dissection of the proper preperitoneal space. In this study, we investigated the conditions required for the correct anatomical approach to the preperitoneal space. METHODS: The anatomo-surgical conditions for dissection of the correct preperitoneal space were evaluated in 10 video studies of TEP repairs. In addition, we also investigated the preperitoneal tissue layers in 10 embalmed human bodies. RESULTS: The proper preperitoneal space can only be approached after cleavage of the ventral component of a bilaminar preperitoneal fascia complex, also known as the posterior lamina of the transversalis fascia. The cleavage can be accomplished spontaneously by a fully expanded balloon correctly introduced into the plane between the rectus muscle and the posterior lamina of the transversalis fascia. CONCLUSIONS: The anatomy of the preperitoneal tissues in the inguinal region is complex. To gain expertise in laparoscopic totally extraperitoneal (TEP) hernia repair, the presence of a bilaminar fascia complex and the importance of the cleavage of the posterior lamina of transversalis fascia must be appreciated.

Cadaver↗
PubMed2004

Morphological changes of the ligamentum flavum as a cause of nerve root compression.

The ligamentum flavum is considered to be one of the important causes of radiculopathy in lumbar degenerative disease. Although there have been several reports anatomically examining the positional relationship between the ligamentum flavum and nerve root, there are few reports on ventral observation. The purpose of this study is to clarify the shape of the ligamentum flavum seen ventrally, and to obtain anatomic findings related to nerve root compression. The subjects were 18 adult embalmed cadavers, with an average age of 78 years at the time of death. The ventral shapes of the ligamentum flavum were observed. The relationships between the morphological change of the ligamentum flavum and nerve root compression or radiographic findings were statistically evaluated. Among the shapes of the ligamentum flavum, bulging of the ligament was most frequently observed. Proximal bulging indicates the type with the cranial portion bulging from the subarticular zone to the foraminal zone of the ligamentum flavum. In this type associated with a decrease in disc height, nerve root compression was frequently observed. Thus, we could more realistically grasp the relationship between bulging morphology of the ligamentum flavum and nerve root compression.

Aged↗
PubMed2002

The microsurgical anatomy of the cisternal segment of the trochlear nerve, as seen through different neurosurgical operative windows.

OBJECTIVE: To describe the anatomy of the cisternal segment of the trochlear nerve as seen through different neurosurgical approaches. METHODS: The cisternal course of ten trochlear nerves was observed in five cadaveric embalmed heads, through the view afforded by the median infratentorial-supracerebellar, the extreme-lateral infratentorial-supracerebellar, and the combined presigmoid-subtemporal transtentorial approaches. The relationships of the trochlear nerve with the surrounding neuro-vascular structures were analyzed. RESULTS: We identified 3 segments of the cisternal trochlear nerve: quadrigeminal, ambient and tentorial. The median infratentorial-supracerebellar approach allowed exposure of the quadrigeminal segment, including the origin of the nerve. The extreme-lateral supracerebellar and the combined presigmoid-subtemporal transtentorial approaches provided visualization of the ambient and tentorial segments of the nerve. The tentorial segment runs in a dural canal contained in the free edge of the tentorium, surrounded by its own arachnoidal sleeve. CONCLUSION: The trochlear nerve is a very delicate structure that can be easily injured during approaches to the tentorial incisura. Accurate knowledge of its anatomy as seen through different operative windows is helpful in maintaining its integrity during surgery.

Brain Diseases↗
PubMed2004

Split lesions of the peroneus brevis tendon in the Japanese population: an anatomic and histologic study of 112 cadaveric ankles.

Split lesions of the peroneus brevis tendon are believed to be rare and have received little attention in populations of Asian countries. The purpose of this study was to investigate the incidence of split lesions in the Japanese population. The peroneus tendons of 112 ankles from 30 male and 26 female adult human embalmed cadavers with an average age of 76.9 years (range, 55-93) were dissected. The presence of split lesions, determined by either thinning or longitudinal splitting of the peroneus brevis tendon, was examined. Forty-two ankles (37.5%) had split lesions, of which 21 (50%) showed a thinning appearance without splitting, and 12 (28.6%) had well-defined, full-thickness longitudinal tears. The incidence of split lesions of the peroneus brevis tendon in the Japanese population was similar to that in studies of the U.S. population, but the condition of the lesions was less severe. Although the clinical presence is expected to be extremely rare, we must consider a neglected split lesion of the peroneus brevis tendon when residual pain is observed in the retrofibular location.

Aged↗
PubMed2005

Efficacy of novel-concept pedicle screw fixation augmented with calcium phosphate cement in the osteoporotic spine.

Pedicle screw instrumentation has become increasingly popular for rigid internal stabilization of the thoracolumbar spine. However, when pedicle screws are used in elderly osteoporotic patients, the screw-bone interface is stripped easily. Therefore, the risk of screw loosening and backing-out after surgery has increased. The purpose of this study was to evaluate the efficacy of the novel-concept pedicle screw fixation augmented with calcium phosphate cement (CPC) in the osteoporotic spine. The novel-concept screw has the same shape as the ordinary screw, but it is hollow and fabricated with 20 small holes (1.3 mm in diameter) leading to the hollow part on the bottom of the thread. Fifteen embalmed cadaveric lumbar vertebrae were instrumented with two types of pedicle screw (the ordinary screw and the novel-concept screw) in each pedicle. Only the novel-concept screws were augmented with CPC after insertion. Seven days later, axial pull-out testing was performed at a crosshead speed of 10 mm/min. The mean maximal pull-out strength of the ordinary screws was 258 N, and that of the novel concept screws was 637 N. These results suggest that the novel-concept screw augmented with CPC can be useful for pedicle screw fixation of the osteoporotic spine.

Aged↗
PubMed2003

Biomechanical evaluation of kyphoplasty and vertebroplasty with calcium phosphate cement in a simulated osteoporotic compression fracture.

Kyphoplasty and vertebroplasty with polymethylmethacrylate (PMMA) have been used for the treatment of osteoporotic vertebral compression fractures. We performed kyphoplasty and vertebroplasty with alpha-tricalcium phosphate cement (CPC) and PMMA to compare the biomechanical properties. Thirty osteoporotic vertebrae were harvested from nine embalmed cadavers. We randomized the vertebrae into four treatment groups: (1) kyphoplasty with CPC; (2) kyphoplasty with PMMA; (3) vertebroplasty with CPC; and (4) vertebroplasty with PMMA. Prior to injecting the cement, all vertebrae were compressed to determine their initial strength and stiffness. They were then recompressed to determine their augmented strength and stiffness. Although the augmented strength was greater than the initial strength in all groups, there was no significant difference between the two bone cements for either kyphoplasty or vertebroplasty. The augmented stiffness was significantly less than the initial stiffness in the kyphoplasty groups, but the difference between the two cements did not reach significance. In the vertebroplasty groups, the augmented stiffness was not significantly different from the initial stiffness. There was no significant difference between the two bone cements for either procedure when cement volume and restoration of anterior height were assessed. We concluded that kyphoplasty and vertebroplasty with CPC were viable treatment alternatives to PMMA for osteoporotic vertebral compression fractures.

Aged↗
PubMed2003

Sonography detection threshold for knee effusion.

The aim of this study was to determine the threshold for detecting knee effusion by ultrasound (US). Five knee specimens from embalmed cadavers were studied. Intra-articular injection of saline, blood and synovial fluid was performed under ultrasound control and methylene blue dye instillation. The smallest amount of fluid detectable by US in the knee was 7.4 ml for synovial fluid, 10.1 and 10.4 ml for saline solution and 9.7 for blood. The threshold for detecting knee joint effusion by US in cadaver specimens was 10 ml for saline and blood and 7 ml for synovial fluid.

Cadaver↗
PubMed2004

The rectogenital septum: morphology, function, and clinical relevance.

PURPOSE: The rectogenital septum (known in clinical literature as Denonvilliers' fascia) forms an incomplete partition between the rectum and the urogenital organs in both men and women. It is composed of collagenous and elastic fibers and smooth muscle cells intermingled with nerve fibers emerging from the autonomic inferior hypogastric plexus. The aim of this study was to investigate the fetal development of the rectogenital septum, and the origin and innervation of the longitudinal smooth muscle cells within the septum, as well as to consider possible effects on function of operations that compromise the integrity of these structures. METHODS: Macroscopic dissections on embalmed human pelves and plastination histology of 40 fetal and newborn pelvic specimens were performed. By means of conventional and immunohistochemical staining methods using monoclonal and polyclonal antibodies for tissue analysis and neuronal labeling, the motor and sensory innervation of the longitudinal muscle bundles within the septum was defined. RESULTS: The rectogenital septum is formed by a local condensation of mesenchymal connective tissue in the early fetal period. The longitudinal muscle bundles could be traced back to the longitudinal layer of the rectal wall, and, using the septum as a guiding structure, it was possible to identify autonomic nerve fibers and ganglion cells innervating the muscle cells and crossing the midline without detectable gender differences. CONCLUSIONS: Because of a coinnervation of the rectal muscle layers and the adjacent longitudinal muscle fibers of the septum, a functional correlation between the two structures during defecation is postulated. On the basis of these findings, a safer dissection of the anterior rectal wall during rectal resection is postulated, thus limiting functional disturbance and preventing neural damage.

Adult↗
PubMed2006

A selfish function of a "social" gland? A postpharyngeal gland functions as a sex pheromone reservoir in males of the solitary wasp Philanthus triangulum.

The postpharyngeal gland (PPG) has long been assumed to be restricted to ants, where it mainly functions in the maintenance of social integrity. Recently, a PPG has been described in both sexes of a solitary digger wasp, the European beewolf, Philanthus triangulum (Hymenoptera, Crabronidae). Female beewolves use the contents of their PPG to embalm their honeybee prey to delay microbial growth. Here we show that in male beewolves, the PPG serves as a reservoir of the pheromone used to scent-mark their territories. Gas chromatography-mass spectrometry (GC-MS) analysis of PPG contents identified 55 substances including long-chain aliphatic hydrocarbons, and 13 substances with functional groups. The composition was consistent with the composition of the marking pheromone of male European beewolves described earlier. Comparisons of the PPG contents, and total-head extracts showed a strong congruency, suggesting that total-head extracts can be used for the analysis of marking secretion in beewolves. Furthermore, we found a dimorphism in the composition of the PPG contents, based on significant differences in the proportions of seven compounds between the two morphs.

Animals↗
PubMed2006

Application of multislice spiral CT for guidance of insertion of thoracic spine pedicle screws: an in vitro study.

To investigate the value of the guidance of three dimensional (3-D) reconstruction of multi-slice spiral CT (MSCT) for the placement of pedicle screws, the 3-D anatomical data of the thoracic pedicles were measured by MSCT in two embalmed human cadaveric thoracic pedicles spines (T1-T10) to guide the insertion of pedicle screws. After pulling the screws out, the pathways were filled with contrast media. The PW, PH, TSA and SSA of developed pathways were measured on the CT images and they were also measured on the real objects by caliper and goniometer. Analysis of variance demonstrated that the difference between the CT scans and real objects had no statistical significance (P > 0.05). Moreover, the difference between pedicle axis and developed pathway also had no statistical significance (P > 0.05). The data obtained from 3-D reconstruction of MSCT demonstrated that individualized standards, are not only accurate but also helpful for the successful placement of pedicle screws.

Bone Screws↗
PubMed1986

Anatomy of human extrinsic cardiac nerves and ganglia.

The anatomy of the human extrinsic cardiac nerves and ganglia was reinvestigated because descriptions of human cardiac innervation vary, detailed analyses of subhuman mammalian cardiac innervation reveal considerable similarities among species and the anatomic pattern of cardiac innervation observed in subhuman mammals differs significantly from those described for humans. The presence of a consistent pattern of cardiac innervation in subhuman mammals raised the question as to whether a similar pattern exists in humans. To investigate this, the cervical and thoracic autonomic nerves and ganglia were dissected in 13 embalmed and 10 autopsy cadavers. All major sympathetic cardiopulmonary nerves were found to arise from the stellate ganglia and the caudal halves of the cervical sympathetic trunks below the level of the cricoid cartilage. These sympathetic cardiopulmonary nerves usually consisted of 3 nerves on the right side and 4 on the left. In contrast to widely accepted reports, no sympathetic cardiopulmonary nerves were found to arise from the superior cervical ganglia or the thoracic sympathetic trunks inferior to the stellate ganglia. Parasympathetic cardiopulmonary nerves were found to arise from the recurrent laryngeal nerves and the thoracic vagi immediately distal to them. These nerves interconnected with sympathetic cardiopulmonary nerves anterior and posterior to the main pulmonary artery to form the ventral and dorsal cardiopulmonary plexuses. These plexuses contained relatively large discrete nerves as well as smaller interconnections. Emerging from these plexuses to innervate the ventricles were 3 distinct relatively large cardiac nerves, the right and left coronary cardiac nerves and the left lateral cardiac nerve. In addition to these 3 major nerves, small cardiac nerves arose from the plexuses and the thoracic vagi. Histologic examination of representative dissections confirmed the presence of neural tissue and identified the locations of neuronal cell bodies in these structures. Cell bodies were located in the nodose, superior cervical, middle cervical, stellate and thoracic sympathetic ganglia. The middle cervical ganglia varied in size and number. Neuronal cell bodies were found in the cervical and thoracic sympathetic trunks and in small mediastinal ganglia located along the courses of the cardiopulmonary and cardiac nerves. Marked similarities exist between the anatomy of the cardiopulmonary nerves and ganglia of humans and baboons.

Adult↗
PubMed1995

The sensate deep inferior epigastric musculocutaneous flap and the twelfth thoracic nerve.

A detailed anatomical study of the terminal branches of the twelfth thoracic nerve (subcostal nerve) based on observations made during dissections of 23 embalmed cadavers is presented. In all 23 cadavers, the twelfth thoracic nerve had an ascending branch which joined the deep inferior epigastric vascular pedicle about half way between the lower border of the umbilicus and the symphysis pubis. This observation, we believe, explains how it is possible to preserve sensation in the deep inferior epigastric musculocutaneous flap.

Adolescent↗
PubMed1983

The assessment of in vivo bone condition in humans by impact response measurement.

Transverse impact tests were conducted on the lower legs of 30 human volunteers and on 18 embalmed human tibiae. The impact was produced by an instrumented hammer and the response was monitored by an accelerometer. The apparent flexural wave velocity, measured from the force and acceleration records, showed significant negative correlations with the ages of both the male and female volunteer groups. The decrease in the velocity with increasing age was more pronounced in the female group. Two patients with bone diseases also manifested a much lower wave velocity compared to that from a normal person of similar age. Results of in vitro impact tests on human tibiae also showed that the wave velocity had: (1) a significant positive correlation with the mass/unit length of bone and (2) a significant negative correlation with the degree of osteoporosis in the bones.

Adolescent↗
PubMed1983

The evaluation of forearm density with axial tomography.

The purpose of the present investigation was to validate axial tomography technique for estimating forearm density. Twenty forearm specimens from six male and four female embalmed human cadavers were used. Segmental mass, volume and density criteria were obtained by weight in air, hydrostatic weight and mass/volume ratio, respectively. Densities of bones and muscles were similarly measured. Segmental density as measured by axial tomography was overestimated by an average of 2.1% and the errors ranged from 0.05 to 4.81%. Results from this study indicated the presence of three density regions in the segment. Moreover, density data were found to be very similar in all zones of the central region of the segment (2/3 of its length) to actual segment density. It is thus actually possible to estimate forearm density in living humans, by taking two scans in the central zone of the segment if data pertaining to tissue densities are available.

Aged↗
PubMed1983

Stress wave propagation in bone.

The traveling wave characteristics for a single compressive pulse were studied in fresh and embalmed human long bones. The stress wave was generated by the longitudinal impact of a steel ball on one end of a bone and was monitored by bonded strain gages. The dynamic properties, namely velocity, attenuation coefficient and dispersion were correlated with the mineral density, porosity, and cross-sectional area of the specimens. Statistically significant relationships were found between several of these parameters. These stress wave propagation characteristics are important for our understanding of the dynamic loading of bone and they may also provide a basis for the development of noninvasive techniques for studies of diseased or fractured bone.

Bone and Bones↗