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At least 397 records · Page 22Linked to original sources
PubMed2002

Anatomical landmarks regarding sacrospinous colpopexy operations performed for vaginal vault prolapse.

AIM: To investigate the anatomical relationships of the structures and the topographic anatomy of the sacrospinous ligament and validate current anatomic knowledge of this area. MATERIALS: Nine embalmed half female cadaver pelvises were dissected to reveal the anatomy of the sacrospinous ligament. RESULTS: The average length of the sacrospinous ligament was measured to be 43.04 +/- 6.58 mm. The inferior gluteal complex emerges from the infrapiriform foramen at a distance of 17.02 +/- 3.08 mm from the ischial spine and courses to inferior-laterally with a slight curve. During this course, it passes close to the upper-lateral half of the sacrospinous ligament. The pudendal complex passes above the spine in six of the nine cases (66.6%) and lies maximum of 5.5 mm medial to the spine. On average the sciatic nerve is measured to be 25.14 +/- 3.94 mm lateral to the ischial spine. CONCLUSION: Placing the suture inferomedially and close to sacrum, the risk of complication will be minimal.

Cadaver↗
PubMed1997

Laparoscopic pelvic lymphadenectomy in an anatomical model: results of an experimental comparative trial.

OBJECTIVES: The aim of this paper was to compare the accuracy of laparoscopic versus open pelvic lymphadenectomy in an experimental trial. STUDY DESIGN: We performed unilateral laparoscopy pelvic lymphadenectomy (LPL) in 33 non-embalmed cadavers between the external iliac vein, the obliterated umbilical artery and the obturator nerve. Then a laparotomy was performed to inspect the LPL limits, look for laparoscopic complications and finally realize a controlateral lymphadenectomy. The LPL side was randomly decided. A pathologist counted the number of lymph nodes collected with both techniques. We compared the number of retrieved lymph nodes, the completeness of the dissection and the complication rate with those two procedures. Student's t-test, chi 2-test and non-parametric tests were used when appropriate. RESULTS: No dissection had to be aborted. One hundred and twelve nodes were removed laparoscopically (mean, 3.73; S.E., 2.9) and 84 at laparotomy (mean, 2.77; S.E., 2.06). There was no significant difference in the number of nodes retrieved with both procedures. Effectiveness of laparoscopy was not significantly different in the first ten procedures, in the second ten or in the last ten LPL. Residual tissue was observed after LPL in 13.3% of the procedures whereas all open lymphadenectomies were complete. LPL sensitivity reached at least 86% in this paper. Failures were more frequent at the beginning of the study (50% among the first ten dissections), in obese subjects or in subjects with prior history of laparotomy (but the difference was not significant). Two venous injuries occurred during LPL (6.7%). Complication rates for the two techniques were not significantly different. However, the LPL complication rate was higher at the beginning of the study and increased significantly in subjects with prior history of laparotomy (P < 0.05). CONCLUSIONS: This randomized study shows that LPL and laparotomy have similar effectiveness. Incomplete dissections and complications are more frequent in obese subjects or in case of prior history of laparotomy. Fifteen procedures seems necessary to learn the technique and provide constant and safe results in routine practice.

Aged↗
PubMed2003

Nerve transfer to deltoid muscle using the nerve to the long head of the triceps, part I: an anatomic feasibility study.

PURPOSE: To experimentally evaluate the feasibility of restoring the motor function of the deltoid muscle in patients with complete C5-C6 root injury (upper brachial plexus injury) by transferring the nerve to the long head of the triceps to the anterior branch of the axillary nerve through a posterior approach. METHODS: The study was performed on shoulder girdles of 36 formalin-embalmed cadavers. The number, diameter, and length of the branches of the axillary nerve at the level of the quadrilateral space were noted. The length and diameter of the nerves to the long head and to the lateral head of triceps at the level of triangular space were recorded. The distances from the acromion angle to the bifurcation of the anterior branch of the axillary nerve, to the origins of the nerve to the long head, and to the origin of the lateral head of the triceps were recorded as well. Nerve biopsy specimens of the axillary nerve and the nerve to the long head of the triceps were obtained from 6 fresh cadavers for histomorphometric evaluation. RESULTS: The average length of the anterior branch of the axillary nerve in this study, measured from the quadrilateral space to the innervating site, was 44.5 mm (range, 26-62 mm), and the average length of the nerve to the long head of triceps, measured from its origin to the innervating site, was 68.5 mm (range, 30-69 mm). The average diameter of the anterior branches of the axillary nerve and the nerve to the long head of the triceps were 2.1 and 1.1 mm, respectively. The average number of axon fibers in the anterior branch of the axillary nerve was 2,704 and in the nerve to the long head of the triceps was 1,233. CONCLUSIONS: Using the acromial angle as the landmark, the combined length of the two 2 nerves was longer than the distance between them. The diameter, the number of axons, and the anatomic proximity of the nerve to the long head of the triceps make it a potential source for reinnervation of the anterior branch of the axillary nerve by direct nerve transfer without nerve grafting through posterior approach for the management of upper brachial plexus injuries.

Axilla↗
PubMed2003

The triquetrum-hamate joint: an anatomic and in vivo three-dimensional kinematic study.

PURPOSE: To obtain anatomic and kinematic information regarding the relative motion of the triquetrum-hamate (TqH) joint. METHODS: In this anatomic study the contact surface constraints of the TqH joint that affect TqH motion were investigated by passively simulating TqH motion according to the kinematic data. Two fresh and 28 embalmed cadaver wrists were dissected. In the kinematic study we studied the in vivo 3-dimensional (3D) kinematics of the TqH joint during radioulnar deviation (RUD) and wrist flexion and extension motion (FEM) in 5 healthy wrists using a magnetic resonance image (MRI)-based markerless bone registration algorithm. Animations of the relative motion of the TqH joint were created and accurate estimates of the relative positions and orientations of the bones and axes of rotation of TqH motion during RUD and FEM were obtained. RESULTS: The anatomic study revealed that the contact surface constraints of the TqH joint include primarily the oval convex surface of the hamate. In the kinematic study TqH motion was likely to be not helicoidal but rotational around an oval convex surface of the hamate. In RUD the triquetral movement was rotation in an ulnoflexion-radial extension plane of the wrist. In FEM it was rotation in an almost flexion-extension plane of the wrist. The axes of rotation of the TqH joint in all wrist motions always ran distal to the TqH joint. CONCLUSIONS: Typical motion of the TqH joint in functional range of motion is not a helicoidal motion on the saddle, but rather a rotational motion on an oval, whose axes of rotation are located on the distal side of the joint.

Aged↗
PubMed1998

An anatomic study of the ligamentous structure of the triangular fibrocartilage complex.

An anatomic study of the ligamentous structures of the triangular fibrocartilage complex and their attachments on the ulnar styloid was performed using 27 embalmed cadaver wrists. The dorsal and palmar distal radioulnar ligaments of the triangular fibrocartilage complex in each specimen contained a superficial and a deep portion. The deep portion of both ligaments inserted on the fovea of the ulna. The superficial portion of both ligaments surrounded the articular disc uniting at the ulnar-most portion of the articular disc. The tissue that is between the ulnar aspect of the superficial ligament (and integrated on its periphery) and the ulnar capsule is defined as the meniscus homologue. Anatomic variations in the meniscus homologue and the prestyloid recess (the cavity adjacent to the ulnar styloid) were seen in 1 of 3 ways; the narrow opening type in 74% of specimens, the wide opening type in 11%, and the no opening type in 15%. The ulnotriquetral ligament inserted on the palmar-radial aspect of the base of the ulnar styloid and the ulnolunate ligament inserted on the palmar border of the articular disc.

Cadaver↗
PubMed1998

Anatomic study of the pisotriquetral joint: ligament anatomy and cartilagenous change.

Eighty embalmed cadaver wrists (40 right and 40 left, 55 male and 25 female, aged 36 to 93 years [average age, 72.5 years]) were dissected to assess the anatomy of the pisotriquetral joint and the location of degenerative changes. The patterns of degenerative changes were classified into five types: type 1, central (8.8%); type 2, peripheral (38.8%); type 3, fan-shaped (13.8%); type 4, mixed (combination of > or =1 of types 1, 2, and/or 3; 10.0%); and type 5, total (12.5%). There was no cartilagenous change in 16.2% of the pisoform and 13.7% of the triquetrum. Degenerative changes (exposed subchondral bone and chondromalacia) on the articular surface of the pisiform were present in 83.3% of the wrists and on the triquetrum in 86.3% of the wrists. Degenerative changes were most commonly of the type 2 pattern (peripheral), with change located most commonly in the distal, distal-radial, and radial aspects of the pisiform and triquetrum. The ligamentous anatomy was categorized into 3 different types: type A, pisohamate and pisometacarpal ligaments inserted on the palmar distal aspect of the pisiform (52.5%); type B, pisohamate ligament inserted on the radial side of the pisiform and pisometacarpal ligament inserted on the palmar side of the pisiform (41.3%); and type C, type B anatomy with an additional ligamentous slip between the pisometacarpal ligament and the distal aspect of the hook of the hamate (6.2%).

Adult↗
PubMed1997

Endothelium on the flow surface of human aortic Dacron vascular grafts.

PURPOSE: We have previously observed endothelium on two human vascular prostheses explanted under optimal conditions for flow surface preservation. In this study we sought to further verify the hypothesis that endothelialization can occur on clinical grafts and that it can be detected in specimens that have been promptly removed and properly preserved in a timely manner. METHODS: We studied 29 aortic grafts. Of these, 11 Dacron bypass grafts were in a condition suitable for analysis with light microscopy and immunocytochemistry staining, and scanning and transmission electron microscopy. RESULTS: Three grafts had endothelium beyond the pannus, identified by factor VIII/ vWF, Ulex europaeus agglutinin, and collagen IV positivity. Specimen A, a knitted 6-year implant, was preserved by embalming 3 hours after the patient's death and had a firmly attached outer capsule with fibroblasts, collagen, giant cells, and microvessels in the interstices. Specimen B, a woven 18-year implant, was retrieved at reoperation and immediately fixed in 10% formalin; it had no outer capsule and no tissue ingrowth. Specimen C, a woven 7-year implant, was removed and fixed 5 hours after the patient's death; it had a firmly attached outer capsule but no tissue ingrowth beyond the outer portion of the wall. CONCLUSIONS: The rapidity with which the specimens were fixed probably enabled identification of endothelium. These findings suggest that endothelialization of synthetic arterial grafts may occur more frequently in human beings than previously recognized.

Aged↗
PubMed1997

Morphology of the axillary nerve in an anteroinferior shoulder arthroscopy portal.

An anteroinferior portal can be safely used in arthroscopic shoulder surgery but requires an in-depth knowledge of axillary nerve anatomy. The purpose of this report is to present the qualitative and spatial anatomy of the axillary nerve and to describe patterns of arborization that may affect safe anteroinferior arthroscopic portal placement. Measurements were taken in 42 embalmed cadaveric shoulders (20 male, 22 female). The distance from the acromioclavicular (AC) joint to the axillary nerve averaged 7.90 cm (range, 7.2 to 9.1 cm) in males and 6.37 cm (range, 5.2 to 8.1 cm) in females. We describe the axillary nerve index (distance of nerve from the AC joint/length of deltoid from AC joint) which can be used to predict the location of the axillary nerve along the anterior clavicular line (ACL). The axillary nerve index averaged 0.48 (range, 0.42 to 0.57) in males and 0.41 (range, 0.31 to 0.57) in females. Four types of morphology were noted in the axillary nerve: (1) main trunk with superior and inferior branches, (2) main trunk with superior branches, (3) main trunk with inferior branches, and (4) main trunk only. Our work supports the traditional operable safe zone for the axillary nerve.

Aged↗
PubMed1998

Humeral attachment of the supraspinatus and infraspinatus tendons: an anatomic study.

We investigated the anatomic relationship of the supraspinatus (SSP) and infraspinatus (ISP) tendons to the three facets of the greater tuberosity. After removing the superficial layer of the cuff to expose the tendon fibers in 10 embalmed shoulders, the cuff tendon attachment to the facets was examined, and the location of attachment was measured in reference to (1) the anterior margin of the greater tuberosity and (2) the superior margin of the sulcus (anatomic neck without cartilage). The SSP tendon attached to the superior facet and the superior half of the middle facet. The ISP tendon attached to the entire middle facet, covering a portion of the SSP tendon. Thus, the anterior half of the superior cuff tendon (12.6 +/- 1.1 mm) was composed of only the SSP tendon, whereas the posterior half (9.8 +/- 3.2 mm) was composed of both the SSP and ISP tendons. The sulcus was located not at the SSP-ISP interval but slightly posterior to the posterior margin of the SSP tendon (4.3 +/- 2.4 mm). We conclude that (1) there is an overlap between the SSP and ISP tendons identifiable by the facets or the distance from the anterior greater tuberosity and (2) the sulcus is located slightly posterior to the posterior margin of the SSP tendon.

Aged↗
PubMed1987

An experimental study of partial intercarpal arthrodesis.

In this experimental study the authors show that partial intercarpal fusions performed on the first carpal row, and not involving the mediocarpal joint, only very slightly limit the mobility of carpal movements: particularly dorsal flexion and radial deviation. Thirty intercarpal fusions were performed with 15 wrists from embalmed cadavers using staples. The range of motions was measured on roentgenograms before and after stapling. The loss of motion was calculated for each type of "partial intercarpal fusion". We present the results with the average loss of motion in percentage and we discuss the indications of these intercarpal fusions, giving for each one the biomechanical explanation of the effects of these intercarpal fusions.

Arthrodesis↗
PubMed1991

Mechanical stability of porous-coated acetabular components in total hip arthroplasty.

Five different porous-coated acetabular prosthetic configurations underwent in vitro testing to assess mechanical stability in embalmed cadaver hemipelves: Harris Galante II cup with three cancellous screws, Biomet Universal cup, Whiteside cup with peripheral pegs, Whiteside cup with two cancellous screws, and plain Whiteside cup. Following implantation in a neutral frame, cyclic load testing was done using 33 specimens at 100-kg load for 100,000 cycles using an MTS machine (MTS Systems Corp., Minneapolis, MN). Subsequently, static load-to-failure testing was done in all specimens. Subsidence and micromovement were determined for each specimen using linear variable differential transformers. With cyclic testing, overall cup subsidence revealed a significant increase, from 500 to 100,000 cycles. Overall cup micromovement revealed a significant decrease, and all cup groups demonstrated less than 125 microns (.125 mm) of average mean micromotion at the completion of cyclic testing. The best cup configuration was a 1-mm, oversized, press-fit cup using two 6.5 cancellous screws for additional fixation, which revealed an average mean of 60 microns (.06 mm) of micromovement. Static load testing revealed unacceptable micromovement over 150 microns (.150 mm) in most cups with 300-kg loads.

Acetabulum↗
PubMed1991

Screw-augmented fixation of acetabular components. A mechanical model to determine optimal screw placement.

Sixteen embalmed hemipelves were used to determine the optimal acetabular screw placement to provide maximal screw pull-out strength in unicortical and bicortical screw fixation. The anterior column, superior ilium, posterior column, ischium, and pubis regions of the pelvis were tested using 6.5-mm titanium alloy screws and a hydraulic servo-controlled 1321 Instron testing machine. Force vs displacement data were acquired. Bicortical fixation was stronger than unicortical fixation in the four zones compared. This difference was significant in the superior ilium, posterior column, and ischium. The anterior column could not accept unicortical screws due to inadequate bone depth, which ranged between only 6 mm and 10 mm. Bicortical fixation was significantly greater in the superior ilium, posterior column, and ischium than in the anterior column or pubis. Unicortical fixation was greatest in the superior ilium. This information may aid decisions concerning the positioning of screws to augment acetabular component fixation.

Acetabulum↗
PubMed1989

In vitro initial fixation of porous-coated acetabular total hip components. A biomechanical comparative study.

Two-phase in vitro testing was performed to determine the initial mechanical stability of uncemented but fixed porous coated acetabular components. Six each of three-screw fixation, two-peg fixation, and three-spike fixation porous acetabular components were implanted into fresh and embalmed human cadaver acetabula. Measurement of prosthesis-bone displacement at a load of 100 kg did not show a significant difference among the three methods of fixation. However, torque testing showed that three-screw fixation failed at significantly higher loads (46 N-m) than two-peg fixation (32 N-m) or three-spike fixation (32 N-m).

Acetabulum↗
PubMed1989

In vitro analysis of proximal femoral strains using PCA femoral implants and a hip-abductor muscle simulator.

The strains produced in the proximal femur by noncemented and cemented PCA femoral implants have been compared to each other and to the strains in the same intact femur. The effect on the strain pattern of a hip-abductor muscle simulator was also tested. Nine embalmed femora were tested; two were used for development of the protocol, one was covered with a reflective photoelastic coating, and six were instrumented with eight strain gauge rosettes on each femur. For a given body weight on the photoelastically coated intact bone, the abductor-simulator increased the mean shear strains on both the medial (132%) and lateral (153%) aspects, with standard deviations of 13% and 20%, respectively; however, no strain-concentrated areas were observed. With an abductor simulator on the strain-gauged femurs, calcar shear strains were significantly reduced (P less than .01), from those on the intact bone, by both noncemented and cemented implants. These reductions were 74.2% and 91.8%, respectively, with no significant difference between the two techniques. Reductions in shear strain were noted at midstem on the medial side for the noncemented (20.5%) and cemented (35.9%) implants; however, only the cemented implants produced significantly less (P less than .05) strain than the intact bone at this location. At midstem on the medial aspect of the femur, there was a significant difference (P less than .05) between the data for the cemented and noncemented implants. Analysis of variance identified no other regions of significant change.

Biomechanical Phenomena↗
PubMed1996

Surgical management of intra- and postoperative fractures of the femur about the tip of the stem in total hip arthroplasty.

Six techniques for the surgical management of fractures of the femur about the tip of the stem of a total hip arthroplasty were evaluated. Seven embalmed human femurs were prepared to receive the correct-size femoral component of a total hip system. A transverse osteotomy was performed at the level of the tip of the stem. Stability and strength of each reconstruction were tested on each femur under semidynamic loading conditions. This study showed that cementless revision to a long-stem prosthesis does not provide adequate stability. The highest strength and stability were achieved by supplementing the long-stem conversion with allograft struts and cable cerclage. Good results were obtained by lateral compression plating with unicortical screws proximally. Failure was due to pull-out of the proximal screws.

Aged↗
PubMed2000

A case of a persistent left vena cava superior with atresia of the right atrial ostium of the coronary sinus.

A persistent left vena cava superior with an atretic ostium of the coronary sinus was found during the routine dissecting course in the embalmed cadaver of an 83-year-old woman who had died from cardiac infarction. The left vena cava superior was very narrow in diameter (4 mm), originated at the lateral part of the left vena brachiocephalica and ran down between the venae pulmonales sinistrae and the auricula sinistra. The vena cava opened into the sinus coronarius of the heart, which terminated as a blind sac due to an atretic ostium. The vena coronaria sinistra as well as the vena interventricularis posterior drained into the sinus coronarius. Congenital atresia of the coronary opening is a rare malformation and is usually associated with other anomalies. The congenital ostial atresia could be the cause of a persistent left vena cava superior, which then takes over the drainage of the cardiac veins.

Aged↗
PubMed2002

[Supplement to the conservation of an entire cadaver according to W. Thiel].

Ten years after publishing the method "The preservation of complete human cadavers in native colours" by W Thiel an improved variant, due to the experiences throughout this time, will be described for the general embalming of corpses and a relating to the apparatus establishment for the preservation of brain in situ.

Autopsy↗
PubMed1996

Variations in the branching of the internal pudendal artery in the ischioanal fossa.

The branches of the ischiorectal part of the internal pudendal artery include the inferior rectal artery and small branches to the obturator internus muscle. For our research we had 164 embalmed half pelves, the arteries of which has been injected by the Thiel method. After the dissection of the ischioanal fossa the arteries were documented. Four types of branching of the inferior rectal artery were found. I. (43%) One artery on each side. II. (31%) Two arteries on one side. III. (4%) Three arteries on one side. IV. (22%) Two arteries or more on each side. In the specimens examined we found one branch to the obturator internus muscle in 31%, two branches in 43% and three branches in 11%. In 15% of cases this branch was absent. In seven cases two branches formed an anastomosis parallel to the internal pudendal artery.

Anal Canal↗