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PubMed1977

Factors affecting the outcome of cadaver renal transplantation in Newcastle upon Tyne.

In an analysis of a series of 186 consecutive first cadaver renal transplants in Newcastle upon Tyne, the most significant finding was the improved graft survival in patients who received pre-transplant blood-transfusion. This apparent benefit was not dependent on the number of units of blood received nor on the interval between transfusion and transplantation. A significant advantage was also shown when there was identity between donor and recipient at the HLA-B locus. This advantage outweighs any disadvantage resulting from the extra time required to transfer kidneys from one centre to another and indeed cold-ischaemia times up to 18 hours did not adversely affect graft survival. It is suggested that the present national distribution of cadaver kidneys in the U.K. is fully justified, but preference should be given to B-locus identity in determining selection.

Blood Transfusion↗
PubMed1999

Shared cadaver donor-husband HLA class I mismatches as a risk factor for renal graft rejection in previously pregnant women.

During the last few years, we have observed four cases in which accelerated rejection of a cadaver donor kidney in a previously pregnant woman could be clearly attributed to the rapid emergence of anti-human leukocyte antigen (HLA) antibodies that had been stimulated by mismatched paternal antigens but were completely undetectable at the time of transplantation. In addition to reviewing those cases, we also reviewed data on 19 other women with a history of at least one pregnancy who underwent transplantation with a first cadaveric kidney since 1991 and were followed for at least six months. The HLA antigens of the husbands had to have been determined and all accelerated rejection or early graft losses due to confirmed or presumed immunological causes were considered. Of the 19 additional women meeting these inclusion criteria, three suffered early immunological graft loss. As in our index cases, two of these women had also received kidneys from donors who shared at least one major immunogenic mismatched antigen with the respective husband for a total of six of seven women with early immunological graft loss. Only one of the 16 women without accelerated rejection or early immunological graft loss had a donor who shared a mismatched antigen with her husband. The difference between the two groups is statistically significant (p = 0.0005). These findings, considered with individual cases reported by other groups, indicate that transplantation from a cadaver donor with immunogenic mismatched class I HLA antigen(s) shared with the husband should be avoided in women with a previous history of pregnancy even when anti-HLA antibodies are not currently detected.

Adult↗
PubMed2001

The effect of single-handed cricoid pressure on cervical spine movement after applying manual in-line stabilisation -- a cadaver study.

Six adult cadavers had 40 N cricoid pressure applied using a cricoid 'yoke' whilst maintaining manual in-line stabilisation of the cervical spine. No other spinal supports were used. Lateral radiographs were taken before and after applying pressure to the cricoid cartilage and the degree of cervical spine movement accurately determined. The median vertical displacements measured from the body of C5 and two other reference points (A and B) on the cervical spine were 0.5 mm (range 0-1.5 mm) and 0.5 mm (range 0-3 mm), respectively. There was no disruption to the lines formed by the anterior or posterior borders of the cervical bodies. We have been unable to demonstrate that single-handed cricoid pressure causes clinically significant displacement of the cervical spine in a cadaver model. This conflicts with previous studies.

Aged↗
PubMed1998

Comparison of the size of plates for fracture fixation with the size of phalanges and metacarpals in cadavers of Asian origin.

The size and volume of plates and screws for fracture fixation of the hand (1.5-mm screws and titanium miniplates, 2.0-mm screws and stainless-steel AO miniplates, and 2.7-mm screws and stainless-steel AO miniplates) were compared against the phalanges and metacarpal bones and the surrounding soft tissue from male cadavers of Asian decent. In the cadaver study, it was first established that the difference between anatomic measurements and radiologic measurements for the interarticular bone length and midshaft width were not significant (p = .09). Second, the volume occupied by the bone showed a close association to interarticular bone length. This finding would suggest that the volume occupied by the bone may be estimated from the radiographs. When the length of the plates was compared to that of the bones, the analysis showed 4-hole and 6-hole 1.5-mm titanium miniplates, and the 4-hole and 6-hole 2.0-mm AO plates were not suitable for the middle phalanx, although only rarely are fractures in the middle phalanx fixed with plates. For the proximal phalanx, only the 4-hole 1.5-mm and 2.0-mm plates were suitable in length. The 6-hole 2.0-mm AO plate was found to be suitable for only the longer proximal phalanx of the middle digit. For the metacarpals, the 5-hole 2.7-mm AO plate was found not to be suitable for the thumb (in length) and the ring digit (in width). The commonly used plates and screws for fracture fixation of the hand may not be suitable in size for groups of people with smaller hand sizes, in particular some Asians and women.

Adult↗
PubMed1998

Reconstruction of the scapholunate ligament in a cadaver model using a bone-ligament-bone autograft from the foot.

This study is an investigation of a new procedure in which the scapholunate interosseous ligament (SLIL) is reconstructed using a bone-ligament-bone autograft from the foot. After investigation, the dorsal medial portion of the navicular-first cuneiform ligament (NFCL) was chosen for testing as a potential donor since it is similar in length and thickness to the SLIL and it is easily harvested with minimal potential donor site morbidity. Eight SLILs and NFCLs were harvested from fresh-frozen cadavers. Biomechanical extensometry testing was performed using an Instron 1000 machine. A 5-mm-wide central portion of the NFCL was tested since this width was compatible with the technical aspects of reconstructing the SLIL. Both ligaments were tested for elastic properties, including stiffness, load to failure, and deformation to failure. Mean length of the NFCL was 7.6 mm (range, 5.5-8.5 mm). Stiffness of the NFCL was 10.6 x 10(5) Nm (range, 8.0-13.0 Nm) compared with 14.4 x 10(5) Nm for the SLIL (range, 10.0-19.5 Nm). Peak load to failure for the NFCL was 1,980 N (range, 1,530-2,940 N) compared with 2,940 N for the SLIL (range, 1,780-4,050 N). Total elongation to failure for the NFCL was 2.50 mm (range, 1.7-3.2 mm) compared with 3.2 mm for the SLIL (range, 2.1-5.2 mm). Thus, the biomechanical characteristics of the NFCL were found to be very similar to those of the SLIL. Having established the biomechanical similarities of the 2 ligaments, we are currently using the NFCL to reconstruct the sectioned SLIL in a fresh-frozen cadaver model. Early results suggest that this procedure is feasible for restoration of normal kinematics of the wrist.

Aged↗
PubMed2002

Evaluation of a teaching laboratory using a cadaver model for tube thoracostomy(1).

A prior study evaluated the efficacy of a dog laboratory to teach residents chest tube thoracostomy. This study evaluated a similarly structured program using human cadavers. A prospective repeat measure study of chest tube thoracostomy placement training was performed in a university laboratory setting using human cadavers. Ten Emergency Medicine residents were given a written pretest, followed by training. Resident attempts were then timed. The following day, a repeat test was administered. Three weeks later, a third written post-test was conducted. The written test scores improved for every participant. Mean times for procedure completion improved from 86 sec to 34 sec during the first session, and remained stable over 4 attempts from 30 sec to 32 sec during the second session. This approach to teaching clinical procedures should be considered for Emergency Medicine residency programs and for continuing education courses that emphasize procedural skills.

Cadaver↗
PubMed1998

Relative strength of photodynamic biologic tissue glue in penetrating keratoplasty in cadaver eyes.

PURPOSE: To compare the relative strength of photodynamic biologic tissue glue (PBTG) with that of 10-0 nylon sutures in closing penetrating keratoplasty (PKP) wounds in cadaver eyes. SETTING: Corneal Research Laboratory, University of Chicago, Chicago, Illinois, USA. METHODS: A 7 mm central corneal trephination was performed on 8 recently enucleated human eyes. Each corneal button was removed and then resutured in its original position, using 4 interrupted 10-0 nylon cardinal sutures and PBTG (n = 7) or 16 interrupted 10-0 nylon sutures (n = 1). Wound leak and incisional bursting pressures were determined. RESULTS: The average pressure at which wound leak and iris prolapse occurred was 124 mm Hg (range 70 to 180) and 185 mm Hg (range 90 to 300), respectively. The pressure required to create wound leak increased as the time between glue application and pressurization of the globe lengthened (mean 22 minutes, range 5 to 60 minutes), indicating that the bonding and stability of the adhesive increased with time. In contrast, the control eye developed wound leak at 70 mm Hg and iris prolapse at 300 mm Hg. CONCLUSIONS: Photodynamic biologic tissue glue was comparable to sutures in providing adequate corneal wound strength in PKP in a cadaver eye model. Wound closure with PBTG may reduce the number of sutures required in corneal transplantation and decrease the incidence of suture-related complications and allograft rejection.

Cadaver↗
PubMed2000

Effect of Healon and Viscoat on outflow facility in human cadaver eyes.

PURPOSE: To compare the acute effects of Healon (sodium hyaluronate) and Viscoat (sodium chondroitin sulfate-sodium hyaluronate) on outflow facility in human cadaver eyes and determine which viscoelastic agent is least likely to cause an intraocular pressure (IOP) spike after cataract surgery. SETTING: The Glaucoma Research Lab, University of Toronto, Ontario, Canada. METHODS: In this prospective paired study, 15 pairs of human cadaver eyes were used. Following the construction of a 3.0 mm scleral tunnel, 0.25 cc of Healon was injected into the anterior chamber of 1 eye and 0.25 cc of Viscoat was injected into the contralateral eye. The viscoelastic agents were removed from both eyes in a standardized fashion and the scleral tunnels closed. The eyes were then perfused at a constant IOP of 8.0 mm Hg, corresponding to 16.0 mm Hg in vivo. Outflow facility (microL/minute [min]/mm Hg) was recorded every 15 minutes for 24 hours using standard methods. RESULTS: Outflow facility in the Viscoat-treated eyes decreased appreciably for the first 3 hours, then recovered somewhat after 12 hours; facility in the Healon-treated eyes showed less of an overall decrease. Over the 24 hour perfusion period, mean outflow facility was 0.037 microL/min/mm Hg +/- 0.015 (SD) in the Viscoat-treated eyes and 0.060 +/- 0.012 microL/min/mm Hg in the Healon-treated eyes. Healon reduced outflow facility significantly less than Viscoat between 3.25 and 10.50 hours postoperatively (P < .05, 2-tailed t test). CONCLUSIONS: Healon reduced outflow facility less than Viscoat between 3.25 and 10.50 hours postoperatively.

Anterior Chamber↗
PubMed2003

Epidermal cell culture model derived from rat keratinocytes with permeability characteristics comparable to human cadaver skin.

The permeability characteristics of an organotypic epidermal culture model derived from rat epidermal keratinocytes, ROC, and isolated human cadaver epidermis, HEM, were compared. Rat epidermal keratinocyte (REK) cell line was grown for 3 weeks on collagen gel in the absence of feeder cells in culture inserts at an air-liquid interface. Transdermal permeabilities of 18 compounds ranging from 92 to 504 in molecular weight and from -4.3 to 3.9 in log of octanol-water partition coefficient, charged or uncharged, were measured in the culture model and isolated human epidermis. The REK organotypic culture model (ROC) provided a close estimate of human epidermal permeabilities over the whole range of the solutes used with on the average of 2-fold higher permeability coefficients (range 0.3-5.2) than those obtained from isolated human cadaver epidermis. The easily maintained and reproducible ROC model may be useful in screening transepidermal drug permeabilities together with possessing potential for research on dermal formulations, irritation, toxicity and gene therapy.

Animals↗
PubMed2000

Bronchial healing, lung parenchymal histology, and blood gases one month after transplantation of lungs topically cooled for 2 hours in the non-heart-beating cadaver.

BACKGROUND: The aim of this study was to investigate, in an experimental survival model, the functional and morphologic results of lung transplantation using lungs from non-heart-beating donors. METHODS: Left lungs, topically cooled to 25 degrees C for 2 hours in situ after 5 minutes of circulatory arrest followed by 26 minutes of unsuccessful cardiopulmonary resuscitation, were transplanted into syngeneic rats. Five weeks after the transplantation, right pneumonectomy was performed and blood gases measured after 60 minutes. In a control group, fresh donor lungs were used for transplantation and comparison was made with the cadaver group and a group of normal rats after right pneumonectomy. Morphologic changes were evaluated by semiquantitative scoring of 13 different parameters to obtain a total histologic index for each rat. RESULTS: Computerized tomography scans of the chest made during the third post-operative week showed normal lung parenchyma in both groups, and at 5 weeks there were no significant differences in blood gases. The bronchial anastomoses showed normal healing in all cases. The histologic changes in the lung parenchyma were generally mild and focal, primarily consisting of interstitial and perivascular mononuclear inflammation, bronchial inflammation and athelectasis. Surprisingly, the transplanted controls demonstrated the most pronounced changes, although only the difference in total histologic index between groups was significant. CONCLUSIONS: Lungs from non-heart-beating donors, topically cooled in the cadaver for two hours after failed resuscitation, showed normal bronchial healing and favorable parenchymal histology compared to transplanted control lungs 5 weeks after transplantation.

Animals↗
PubMedDate not supplied

Comparison of humeral head retroversion with the humeral axis/biceps groove relationship: a study in live subjects and cadavers.

The purpose of this study was to investigate whether the axis of the humeral articular surface bears a more constant relationship to the bicipital groove than to the distal humerus. This finding could help intraoperative placement of a shoulder prosthesis in the most anatomic position. Magnetic resonance imaging was used in 41 live volunteers and 9 cadavers to measure the distance from the biceps groove to a line drawn perpendicular to the midpoint of the humeral articular surface. A cadaver model with a plastic humeral prosthesis was used to convert this biceps distance into an angular measurement. The relationship between the biceps distance and the retroversion angle of the humeral head with respect to the humeral epicondyles was analyzed. The biceps distance averaged 11.8 mm+/-3.5 mm (equivalent to 26.8 degrees+/-8.3 degrees), whereas retroversion averaged 26.8 degrees +/-12.2 degrees. This difference in variability is significant (P=.008). Placing the fin of a humeral head implant 12 mm posterior to the biceps groove reproduces normal anatomy better than the use of an arbitrary standard of 30 degrees to 40 degrees of retroversion.

Adult↗
PubMed1998

Radiographic and morphologic studies of multiple miliary osteomas of cadaver skin.

OBJECTIVES: The purpose of this study was to examine the frequency, chemical composition, and radiographic and morphologic features of multiple miliary osteomas of the facial skin. STUDY DESIGN: Facial skin was obtained from 33 cadavers. After contact radiographs were taken, osteomas were examined by photo and scanning electron microscopy. Radiographic microanalysis of inorganic elements of the osteomas was also performed. In addition, clinical dental radiographic examinations were performed on 158 living subjects. RESULTS: Radiographic examination revealed milia-like osteomas in the facial skin of all of the cadavers. Nodules of 0.5 to 2.0 mm in diameter were scattered symmetrically in the skin of the cheek, mandibular angle, and forehead. Each nodule consisted of a concentric, multilamellated, osteoid cortex and an adipose medulla. Microanalysis suggested the presence of hydroxyapatite similar in composition to that of normal cortical bone. The condition was detected in 28% (44/158) of the living subjects by clinical dental radiographic examination. CONCLUSION: Multiple miliary osteoma is a very common condition and may not be related to specific diseases.

Adipose Tissue↗
PubMed1998

Human cadaver skin viability for in vitro percutaneous absorption: storage and detrimental effects of heat-separation and freezing.

PURPOSE: For decades, human cadaver skin has been banked and utilized by hospitals for burn wounds and to study percutaneous absorption and transdermal delivery. Skin storage maintenance and confirmation of skin viability is important for both uses, especially for the absorption process where the in vivo situation is simulated. METHODS: Our system uses dermatomed human cadaver skin immediately placed in Eagles MEM-BSS, and refrigerated after donor death, then transferred to the laboratory and placed in Eagles MEM-BSS with 50 micrograms/ml gentamicin at 4 degrees C for storage. RESULTS: Skin viability, determined by anaerobic metabolism where glucose is converted to lactose, was highest (p < 0.000) during the 18 hours of the first day after donor death, decreased some 3-fold by day 2 (p < 0.000), but then maintained steady-state viability through day 8. Viability then decreased by approximately one-half by day 13. Thus, using the above criteria, human skin will sustain viability for 8 days following donor death in this system. Heat-treated (60 degrees C water for one minute) and heat-separated epidermis and dermis lose viability. CONCLUSIONS: Human skin viability can be maintained for absorption studies. It is recommended that this system be used, and that heat-separation and skin freezing not be used, in absorption studies where skin viability and metabolism might be contributing factors to the study.

Administration, Cutaneous↗
PubMed2000

Do six-antigen-matched cadaver donor kidneys provide better graft survival to children compared with one-haploidentical living-related donor transplants? A report of the North American Pediatric Renal Transplant Cooperative Study.

Since 1991, more than 50% of pediatric transplant recipients have received a living donor (LD) kidney, and approximately equals 85% of these allografts were one-haploidentical parental kidneys. Short-term (1 yr) and long-term (5 yr) graft survival of LD kidneys are 10% and 15% better, respectively, than that of cadaver donor (CD) kidneys. Because of these results, children are frequently not placed on a cadaver waiting list until the possibility of a LD is excluded--a process that may take up to 1 yr. The hypothesis for this study was that the graft outcome of a six-antigen-matched CD kidney is superior to that of a one-haploidentical LD kidney, and that children are at a disadvantage by not being placed on a CD list whilst waiting for a LD. The database of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) for 11 yrs (1987-98), was reviewed to identify children who were recipients of a six-antigen-matched CD kidney (primary and repeat transplants), and those who were recipients of a one-haploidentical LD kidney (primary and repeat transplants). Using standard statistical methods, the morbidity, rejection episodes, post-transplant hospitalizations, renal function, long- and short-term graft survival, and half-life of primary recipients were compared in the two groups. Unlike adult patients, only 2.7% (87/3313) of CD recipients in the pediatric age range received a six-antigen-matched kidney, and the annual accrual rate over 11 yrs was never higher than 4%. Comparison of 57 primary six-antigen-CD kidneys (PCD) with 2,472 primary LD (PLD) kidneys revealed that morbidity, rejection rates, and ratios were identical in the two groups. Renal function and subsequent hospitalizations were also identical in the two groups. Five-year graft survival of the PCD group was 90% compared with 80% for the PLD group, and the half-life of the PCD group was 25 +/- 12.9 yrs compared with 19.6 +/- 1.3 yrs. Our data suggest that the six-antigen-matched CD kidney may have less graft loss as a result of chronic rejection and would therefore confer a better long-term outcome. Based on these findings we recommend that all children, whilst waiting for a LD work-up, be listed with the United Network for Organ Sharing (UNOS) registry for a CD kidney.

Cadaver↗
PubMed1994

Screening and confirmatory testing of cadaver organ donors for hepatitis C virus infection: a U.S. National Collaborative Study.

Hepatitis C virus (HCV) can be transmitted by organ transplantation. Cadaver organ donors are screened for HCV infection by testing for antibodies to HCV (anti-HCV). The prevalence of HCV infection and performance of anti-HCV tests in detecting HCV infection in organ donors are unknown. Sera from 3078 cadaver organ donors were tested for anti-HCV by a first generation enzyme-linked immunosorbent assay (ELISA1). Sera from all 137 ELISA1 positive donors and a random sample of 92 ELISA1 negative donors were tested for anti-HCV by a second generation ELISA (ELISA2) and for HCV RNA by the polymerase chain reaction. Organ bank records were reviewed for risk factors associated with HCV infection. Follow-up was available on 70 recipients of organs from 42 ELISA2 positive donors. The prevalence of HCV RNA, extrapolated to all 3078 donors, was 2.4%. Liver disease, anti-HCV and HCV RNA were detected more frequently among recipients of organs from ELISA2 positive donors with HCV RNA than from ELISA2 positive donors without HCV RNA. Among donors, the sensitivity and negative predictive value of the ELISA2 for HCV RNA were 100%. However, despite a specificity of 98.1%, the positive predictive value was only 55.1%. Clinical and laboratory characteristics did not distinguish ELISA2 positive donors with and without HCV RNA. The presence of serum HCV RNA in organ donors predicts the risk of transmission of HCV infection. Discarding organs from ELISA2 positive donors would eliminate transmission, but organs from 1.88 percent of donors would be wasted.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2003

Cadaver-assessed validity of anthropometric indicators of adipose tissue distribution.

Although the waist-to-hip ratio (WHR) has emerged as the best anthropometric indicator of the body's adipose tissue distribution, it has never been directly validated. Waist and hip girths, and triceps and subscapular skinfold thickness were measured in 12 male and 13 female cadavers aged 55-94 y. Adipose tissue from the upper limbs, lower limbs, subcutaneous trunk and intra-abdominal regions was then separated by dissection and weighed. Adipose volumes were also determined by hydrostatic weighing. The following adipose tissue mass ratios (and corresponding volume ratios) were derived: trunk to sum of lower limbs, trunk to sum of upper and lower limbs, intra-abdominal to sum of lower limbs and intra-abdominal to sum of upper and lower limbs. Centrality index (CI-subscapular-to-triceps skinfold ratio) and WHR were regressed on the tissue mass and volume ratios of the 25 cadavers. WHR was significantly related to mass and volume ratios for the 12 men (R2=36.0-57.5%, P<0.05), except for intra-abdominal to sum of upper and lower limbs (R(2)=26.3%, P=0.09), but none of these relations was significant in the women. CI was significantly related to all mass and volume ratios only for men and women combined (R(2)=16.2-21.8%, P<0.05). The WHR was better related to all mass and volume ratios than the CI. These results, especially the strong association between WHR and the ratio of intra-abdominal to lower limb adipose masses (R(2)=35.4%, P=0.002), demonstrate a clear relation between the selected anthropometric variables (hip and waist girths, and subscapular and triceps skinfolds) and adipose tissue distribution, thus validating the use of WHR as an important predictor of health risk.

Abdomen↗
PubMed1999

The laryngeal mask airway in fresh cadavers versus paralysed anaesthetized patients: ease of insertion, airway sealing pressure, intracuff pressures and anatomic position.

We compared the performance of the size 5 laryngeal mask airway in 20 paralysed anaesthetized male patients and 20 male cadavers (6-24 h post-mortem). Groups were matched for height and weight. Airway sealing pressure, in vivo intracuff pressure and anatomical position (judged fibre-optically) were documented at zero volume and after each additional 10 mL up to 40 mL. All laryngeal mask airways were inserted at the first attempt and insertion times were similar. There were no differences in airway sealing pressure, in vivo intracuff pressure or fibre-optic position between the groups. We conclude that the performance of the laryngeal mask airway is similar for fresh cadavers and paralysed anaesthetized patients. This may have implications for laryngeal mask airway research and training.

Adult↗
PubMed2001

Estimation of age of human cadavers by immunohistochemical assessment of advanced glycation end products in the hippocampus.

AIMS: Advanced glycation end products (AGEs) are known to accumulate in long-lived tissue proteins during normal ageing. In this study, we examined the expression of AGEs in human hippocampus using immunohistochemistry and determined its utility for estimating the age of cadavers of unknown age. METHODS AND RESULTS: Hippocampus tissues were obtained at autopsy from 31 individuals, including 10 fire victims, aged 0--96 years within 3 days postmortem. Immunostaining using anti-AGE antibody demonstrated that the perikarya of pyramidal neurones in the hippocampus was immunoreactive for the anti-AGE antibody, and the immunoreactivity was increased with age. Quantitative analysis of the AGE-immunoreactivity in the pyramidal neurones of the CA4 region revealed a significant correlation between the AGE-immunoreactivity and the age in nonfire death cases with a correlation coefficient of 0.91 (P < 0.01). The significant correlation could be obtained even in fire death cases affected by the unusual environmental condition. CONCLUSIONS: These results suggest that the immunohistochemical analysis of AGEs in human hippocampus may be useful for the age estimation of cadavers with unknown age.

Adolescent↗