Hospital did not commit battery on mortician who embalmed HIV-infected corpse.
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HIV Infections↗
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"The soft embalmer of the still midnight": a problem of prescribing hypnotics in general practice.
Was it euthanasia or was it even murder? That is the rather dramatic question with which the case history ends. However, none of those taking part in this conference had any doubts that it was neither murder nor euthanasia. But all had doubts as to whether the patient received the best care which the medical and allied professions can command. The barrister declared that in law there would have been no case to answer but the consensus of opinion of the other participants was that as no real diagnosis had been made the treatment was essentially superficial - ensuring sleep for the patient by prescribing barbiturates. The most fundamental criticism of the management of this patient was that individuals looked after her rather than an interdisciplinary team, some member of which might properly have sought to overrule Dorothy (the patient's daughter) when she took her mother away from a nursing home. However, what makes this case conference fascinating is not the facts of the case or the treatment so much as the avenues for moral and social discussion opened for the reader.
Aged↗
[Use of a mechanical device for long-term storage of embalmed cadavers in an anatomy department].
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Anatomy↗
Health status of funeral service workers exposed to formaldehyde.
A study of 84 funeral service workers and 38 control subjects in Toronto, Canada, revealed that the embalmers reported chronic bronchitis, dyspnea, and nasal, eye, and skin irritation more frequently than controls. Apprentices reported symptoms and exhibited signs of irritation more frequently than experienced embalmers, but both of these groups were more affected than the inactive embalmers or the controls. Airborne formaldehyde levels were 0.36 +/- 0.19 ppm (mean +/- standard deviation) during 22 embalming procedures. General ventilation was shown to significantly lower the levels. No significant change in forced vital capacity, forced expiratory volume in 1 sec, FEF50 or FEF75 was demonstrated with formaldehyde exposure nor were the baseline lung function results significantly different from those 38 unexposed controls. Based on patch testing, 4% and 10% were sensitive to formaldehyde and glutaraldehyde, respectively, whereas none of the controls exhibited positive reactions.
Adult↗
Phenoxyethanol as a nontoxic preservative in the dissection laboratory.
In an effort to rid the dissection room of irritating and potentially health-threatening toxic chemicals, we have modified the phenoxyethanol technique for long-term preservation of embalmed cadavers. The new methods employ faster, less toxic embalming and reduced or eliminated phenoxyethanol immersions. Our results are comparable with or improved over those previously described and demonstrate that phenoxyethanol is an excellent, easily manageable alternative preservative to standard formaldehyde/phenol-based embalming fluids.
Aged↗
An unusual injury.
The case of a young man who died unexpectedly from myocarditis is presented. The body was partially embalmed before autopsy at the Victorian Institute of Forensic Pathology. Although the cause of death was not a problem to diagnose, this case highlights artefacts that embalming may cause and the difficulties it may create with interpretation of injury. This is of particular relevance to those forensic pathologists who only uncommonly see injuries which are due to embalming.
Adolescent↗
Recognition of cemetery remains in the forensic setting.
Cemetery remains exposed through vandalism or natural phenomena are frequently brought to the attention of law enforcement agents or medical examiners. Although it is often difficult to distinguish cemetery remains from those of medicolegal significance, clues to their origin may exist. Characteristics consistent with cemetery remains include physical characteristics associated with the embalming process. Characteristics indicative of cemetery remains include functional or ornamental artifacts associated with the coffin, devices used in embalming the body, and elevated levels of embalming chemicals in the soft tissue.
Burial↗
Universal precautions and mortuary practitioners: influence on practices and risk of occupationally acquired infection.
Embalming, the most common funeral practice in the United States, may expose the embalmer to infectious diseases and blood. We surveyed the 860 members of the National Selected Morticians in 1988 to estimate the incidence of self-reported occupational contact with blood and infectious disease, assess morticians' knowledge of acquired immunodeficiency syndrome (AIDS), determine their adherence to universal precautions, and identify predictors of practices designed to reduce risk of occupational exposure to infections. Of 539 (63%) respondents, 212 (39%) reported needle-stick injuries in the past 12 months, and 15 (3%) reported percutaneous exposures to the blood of a decedent with AIDS. Those rating the risk of occupationally acquired human immunodeficiency virus infection as very high or high (194/539 [36%]) were more likely to decline funerals of decedents with antemortem diagnosis of AIDS (59/194 [30%]) and/or to charge more for such funerals (133/194 [69%]) than those who rated the risk as low to moderate (31/345 [9%], 174/135 [51%]).
Acquired Immunodeficiency Syndrome↗
Contact dermatitis in funeral service workers.
84 funeral service workers and 38 control workers were evaluated for the presence of skin disease by history, clinical examination and patch tests with formaldehyde and glutaraldehyde. No relationship between either personal or family history of cutaneous or respiratory manifestations of atopy and clinical parameters of cutaneous disease or patch test results was found. Cutaneous disease was reported in apprentices, active embalmers and inactive embalmers in decreasing order of frequency. Positive patch test reactions to formaldehyde and glutaraldehyde were found in 4% and 7% of the exposed workers, but in none of the controls. Although exposure to glutaraldehyde was less frequent, the prevalence of positive patch test reactions did not differ. This may suggest that glutaraldehyde poses a greater practical risk of cutaneous sensitization in this trade than formaldehyde.
Adult↗
[Preservation of human cadavers throughout history--a contribution to development and methodology].
From ancient times to nowadays man tried out of different intentions to keep the bodies of dead persons in the best possible state of preservation. The embalming procedures primary aim at avoiding or at least stopping rottness and autolysis. They have to change depending on the technical possibilities and further destiny of the embalmed bodies. Beside a short historical review we present the method used at our institute.
Autopsy↗
Formaldehyde and paraformaldehyde study in funeral homes.
Formaldehyde is a toxic gas and classed as an upper respiratory irritant. The gas possesses distinctive physiological properties causing symptoms familiar to many formaldehyde workers, such as: burning of the eyes, lacrimation, and general irritation of the upper respiratory passages. To demonstrate this toxic action of formaldehyde a study was conducted in embalming rooms of funeral homes to determine the concentration and its effect on the embalmers at this level. The control measures in these establishments were also evaluated and found to be inadequate in some respects. Paraformaldehyde powders were sized and found to contain a respirable fraction. The results of the study show that these workers verified the fact that formaldehyde is an irritant at levels that are below the present Threshold Limit Value.
Air Pollutants, Occupational↗
Gynecomastia in a mortician. A case report.
The fine needle aspiration (FNA) observations in a case of gynecomastia occurring in a mortician are described. The FNA smear showed cytomorphologic features typical of a gynecomastia. Morticians use an embalming cream that contains estrogens or estrogenlike compounds; these substances may be absorbed percutaneously and cause the development of gynecomastia. The mortician should be made aware of the potential risk of such an occupational exposure and development of the "embalmer's curse. "Recognition by the clinicians and cytopathologists of such an occurrence and its implications can help with the proper management.
Adult↗
[The preservation of the whole corpse with natural color].
An especially low-odor embalming technique was developed over a 30-years-period using a total of 977 complete cadavers, numerous cadavers after autopsy, and in vitro series of fresh beef. The color, consistency, and transparency of the tissue were very well preserved. The technique met high standards of preservation without releasing harmful substances into the environment. Concentrations of formaldehyde in room air remained under the limit of detection by Dräger capillaries. The efficacy for disinfection of the method was confirmed by bacteriologic tests. None of the cadavers or samples developed molds.
Animals↗
Mechanical properties and histology of cortical bone from younger and older men.
Tensile breaking load, strength, strain, modulus of elasticity and density plus the histological structure at the fracture site, were determined for 207 standardized specimens of cortical bone from the embalmed femur, tibia, and fibula of 17 men from 36 to 75 years of age. The men were divided into a younger group (41.5 years old-avg)) and an older group (71 years old-avg). Specimens from younger men had a greater average breaking load, strength, strain, modulus and density than those from older men. The percentage of spaces in the break area was greater in specimens from older men, but specimens from younger men had a slightly greater percentage of osteons, osteon fragments, and interstitial lamellae. The number of osteons/mm2 and of osteon fragments/mm2 was greater in specimens from older men but the average area/osteon and area/osteon fragment was greater in specimens from younger men. Thus, there are quantitative and qualitative differences in the histological structure of bone from younger and older men. Differences in the tensile properties of bone from younger and older men can be explained by histological differences in the bone.
Adult↗
Human abductor pollicis brevis muscle "divisions" and the nerve hila.
The interpretation of neuromuscular impairment may be aided by an analysis of functional anatomic factors. The anatomy of the abductor pollicis brevis (APB), a muscle used for skilled movements, was investigated in 19 embalmed hands, and the muscular divisions joining the common tendon at different sites were reproduced on clear vinyl sheets. The median nerve pathway to thenar muscles was followed to where it divides to the APB nerve and to the sites of the main terminal hila. Transverse (x) and longitudinal (y) muscle axes were established with the aid of landmarks to reproduce the nerve pathway on the skin surface. In the rather thick APB, three groups of six muscular heterogeneous divisions were regularly present. The dorsal aponeurotic expansion of the thumb receives the first group. The second group forms a continuous vertical line from the base to the body of the first phalanx. The outside site of its lateral tubercle takes the central tendon from the penniform third group. Hence, a reverse figure-seven distal insertion can be observed. The deepest medial (V2) and the most superficial lateral (V3) divisions had the highest mean diameters. The APB nerve fell between V2 and V2' and its line of projection supplied a guideline to establish an x axis at the proximal one-third of the muscle. The nerve hila plotted in relation to the x-y axes revealed a mode of location. The classical description of a thin APB muscle, made up of two bellies of parallel fibers seems incorrect. The APB nerve is not found on the deep aspect of the muscle as stated earlier, but within the muscle. The well-innervated muscular divisions point to the possibility of their individual use. The APB neuromuscular projection to the skin should allow more accurate fundamental EMG studies of the thumb and therefore provide a basis for more effective treatment in cases of impaired APB.
Humans↗
The inferior thyroid veins--the ultimate guardians of the trachea.
The inferior thyroid veins and their multiple tributaries are the ultimate guardians of the cervical trachea. Deeply embedded in the pretracheal fat pad, this plexus of veins is consistently encountered during low tracheostomy that accompanies conservation laryngral procedures as well as in tracheal reconstruction. In a high tracheotomy, the handling of the thyroid isthmus is simplified by an appreciation of these veins. Even cricothyrotomy is potentially complicated by hemorrhage sebsequent to a tear in a tributary of the inferior thyroid venous system. A cadaver study, employing 10 embalmed head and neck specimens, was performed to elucidate the tributary patterns of these veins. In every dissection there was at least one and as many as five veins overlying the trachea just below the thyroid isthmus. In 7 of 10 dissections a confluence of right and left inferior thyroid veins formed a large thyroid ima vein draining into the left innominate vein, and in 1 of 10 cases the thyroid ima vein drained into the right innominate. This confluence was present at a level which would be encountered in low tracheostomy or tracheal repair procedures. Six of 10 dissections presented large tributaries of the inferior thyroid veins overlying the cricothyroid membrane. An awareness of such anatomical considerations should result in safer surgical procedure performed in a dry operative field.
Humans↗
Paleoradiologic evaluation of the Egyptian royal mummies.
We examined radiographs of 12 Egyptian royal mummies obtained by two of the authors (W.R. and J.E.H.) and never before published. These radiographs demonstrate findings not previously described in Egyptian mummies, including congenital lunate-triquetral fusion and destructive skeletal lesions not explainable on the basis of vandalism by tomb robbers. Antemortem fractures, degenerative joint disease, and arterial vascular calcification were also seen. In 11 of the 12 cases, there was chondrocalcinosis of intervertebral discs or menisci, probably an artifact of embalming. Visceral packing and skeletal deformity due to wrapping were observed, as well. Radiology provides important paleopathologic and archeologic information for the accurate, comprehensive study of Egyptian mummies.
Bone Diseases↗
The fibrous frame of the supraspinatus muscle. Correlations between anatomy and MRI findings.
30 MRI investigations of shoulders and 20 dissections of non embalmed cadaveric shoulders allowed us to demonstrate a particular organization of the supraspinatus muscle. In the anterior part of the muscle is an important fibrous frame with obliquely inserted muscle fibers. This organization suggests that this part of the supraspinatus muscle works as a "contractile tendon".
Humans↗