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PubMed1975

In situ preservation of cadaver kidneys for transplantation: laboratory observations and clinical application.

Many kidneys obtained from cadaver donors undergoing sudden cardiac arrest cannot be transplanted due to the long periods of warm ischemia from the moment of arrest to nephrectomy. A double-ballon-triple-lumen catheter for the rapid in situ preservation of cadaver kidneys has been designed. Used in combination with equipment routinely found in any hospital, it can cool human kidneys in situ to 10-15 C and maintain this temperature until nephrectomy can be performed. Kidenys preserved with this catheter have functioned after transplantation into suitable recipients. This report describes the design and laboratory evaluation of this new device, its clinical effectiveness and technique of insertion.

Adolescent↗
PubMed1976

Seven years' experience with antilymphoblast globulin for renal transplantation from cadaver donors.

Antibody of the IgGab type can be isolated from horses immunized with cultured human lymphoblasts plus complete Freund's adjuvant. The essential steps for the production of a safe, potent anti-human lymphoblast globulin (ALG) are: A) the use of early bleedings after immunization to reduce the titer of antibodies which react with red blood cells and platelets; B) careful absorption with human red blood cell stroma and platelets; C) stabilization with non-crystalline silica dioxide; D) chromatography through QAE sephadex to remove pyrogens, microaggregates and possible inhibitors of ALG activity; E) careful safety testing in animals for toxicity and pyrogenicity; and F) testing in vitro for sterility. Such a purified horse ALG (IgGab) can be administered safely intravenously to patients to supplement a standardized immunosuppressive regimen incorporating azathioprine and prednisone. Under these circumstances, allergic reactions are very rare, antibodies to horse IgG do not develop, skin tests to horse IgG remain negative, and immune elimination of circulating horse IgG from the human circulation cannot be demonstrated. The overall results of ALG patient survival and transplant function after 184 consecutive first cadaver transplants at the University of Minnesota demonstrate a statistically significant improvement in both parameters accompanying increases in ALG dose while rigidly utilizing standardized doses of azathioprine and prednisone. There is a significant reduction in the number of grafts lost to rejection; significant reduction in the number of rejection episodes; significant delay in the onset of rejection episodes; but there is no increase in septic loss of patients or kidneys. These efforts could be seen in the gross data or when subgroups controlling for patient age, tissue typing were analyzed. Excluding patients at high risk did not alter the results. The beneficial effects of ALG were particularly striking in good matches. In the highest doses, ALG may be dangerous for older patients with poor matches who develop an increased incidence of septic loss of kidney and/or life. Thus, ALG appears to be a useful adjunct in the early management of cadaver transplants by reducing the incidence and frequency of rejection episodes. The dose should probably be reduced in the older patients who receive kidneys from badly mismatched donors. One cannot conclude from this study that ALG manufactured in other centers by this or other techniques, will accomplish the same results since the multiplicity of factors involved in the success and failure of transplants must be controlled so that the influence of intravening variables in the assessment of ALG effectiveness can be assessed.

Age Factors↗
PubMed1980

Effect of splenectomy on first cadaver kidney transplants.

A prospective study was begun in January 1975 to evaluate the effect of splenectomy on graft and patient survival in recipients of first cadaver kidney transplants. Ninety-two cases were evaluated. Splenectomy increased the survival of both grafts and recipients. The benefit from splenectomy compensated readily for the perioperative morbidity of splenectomy and the long-term increased risk of sepsis from certain bacteria for the asplenic patient. Splenectomy exerted its effect by reducing the incidence and intensity of rejection episodes. It was not clear whether the observation resulted from a direct immunosuppressive effect of splenectomy or from the increased tolerance to azathioprine observed in asplenic recipients. Finally, splenectomy negated an effect of race that had been observed earlier for survival of cadaver transplants and recipients.

Adult↗
PubMed2002

Comparison of the pull-out forces of bioabsorbable polylactide/glycolide screws (Biosorb and Lactosorb) and tacks: a study on the stability of fixation in human cadaver parietal bones.

The aim of this study was to compare the pull-out forces of bioabsorbable polylactide/glycolide (PLGA) tacks and screws in human cadaver parietal bones. Parietal bone pieces (c. 6 cm x 20 cm) were collected from five human male cadavers (age range: 47-75 years). Forty-nine BioSorbPDX (self-reinforced [SR] PLGA 80/20) tacks (1.5-mm diameter, 4.0-mm length), 47 BioSorbPDX (SR-PLGA 80/20) screws (1.5-mm diameter, 4.0-mm length), and 46 LactoSorb (PLGA 82/18) screws (1.5-mm diameter, 4.0-mm length) were applied. The tacks were applied to drill holes using a special applicator gun (no tapping or tightening). The screws were applied to drill holes in the traditional way using tapping and tightening with a screwdriver. A tensile testing machine was used. All the implants were tested thus: the head of the implant was held by an aluminum jig, and the jig was pulled with wire until implant failure. The testing pull speed was 10 mm/min. Means and SDs were calculated, and the data were analyzed using ANOVA. The pull-out force of the tacks was 115.9 +/- 8.3 N, that of Lactosorb screws was 112.9 +/- 12.1 N, and that of Biosorb screws was 110.4 +/- 8.9 N (statistically insignificant difference between the three groups). The most common reason for failure in the case of tacks was barb breakage (55.1%); it was thread breakage in the case of BioSorb screws (66%) and stem split in the case of Lactosorb screws (56%). Tacks seem to have a similar, perhaps even a little better, holding power to cranial bone as screws and can hence be recommended for clinical application, as the procedure saves time and, consequently, costs.

Absorbable Implants↗
PubMed1992

Cardiac anatomy instruction by ultrafast computed tomography versus cadaver dissection.

RATIONALE AND OBJECTIVES: This prospective study was designed to determine to what extent an ultrafast computed tomography (UFCT) videotape of the heart could enhance or substitute for cadaver dissection in teaching anatomy to first-year medical students. METHODS: A student population (n = 180) was randomized into four groups. Group 1 (control) received no instruction, group 2 viewed the videotape, group 3 participated in cardiac dissection, and group 4 performed cardiac dissection and viewed the videotape. After randomized instruction, each group was tested with 10 UFCT static cardiac images and 8 cardiac cadaver specimens. A different population consisting of nonrandomized fourth-year medical students also was tested. RESULTS: The results point to an interaction between instruction and the manner in which it was assessed. There was more carryover from the videotape-acquired knowledge to specimens than from dissection-acquired knowledge to UFCT images. CONCLUSIONS: Cardiac UFCT instruction resulted in dramatically improved image testing performance. This image-acquired knowledge was not sufficiently transferred to cardiac specimen identification; thus, videotape instruction should not replace dissection for teaching cardiac anatomy. Video provided instruction benefits beyond that gained through general clinical experience.

Audiovisual Aids↗
PubMedDate not supplied

MR artifacts after anterior cervical diskectomy and fusion: a cadaver study.

OBJECTIVE: To identify the source of metallic artifacts observed on cervical spine MR studies following anterior cervical diskectomy and fusion (ACD&F), preoperative and postoperative MR studies were done on cadavers using standard spin echo T1, T2, and GRASS imaging. MATERIALS AND METHODS: An ACD&F was performed on each cadaver at various levels using different combinations of drill burrs, curettes, and suction tips. RESULTS: Results showed that contact between the drill burr and suction tip produced the worst artifacts; however, artifacts still occurred in cases in which the suction tip was not introduced. CONCLUSION: This observation suggests that metal flakes from the curettes also produced artifacts. Image distortion was greater on GRASS imaging than on the spin echo imaging.

Artifacts↗
PubMed2000

Quality of root-end preparations using ultrasonic and rotary instrumentation in cadavers.

Prior investigations have demonstrated dentinal cracking and chipping during ultrasonic preparation of the root-end. This study compared the frequency of cracking and chipping in two groups, cadaver and extracted teeth, using an indirect resin technique. Preparations were performed using either a 33 1/2 inverted cone bur in a high-speed handpiece, or with ultrasonics using a CT-2 tip at either high or low intensity. After replication of the root-end in epoxy resin, all teeth were evaluated for cracking and chipping under scanning electron microscopy. Statistical analysis using a general contingency table or ANOVA with Scheffé post-hoc analysis (p = 0.05) revealed no significant difference between all groups in terms of root-end cracking. In extracted teeth (n = 15), rotary instrumentation produced less chipping than either ultrasonic technique. Varying the intensity was not significant. There was no significant difference between any instrumentation group in cadaver teeth (n = 10) related to the amount of chipping.

Analysis of Variance↗
PubMed1987

Biosynthetic skin substitute versus frozen human cadaver allograft for temporary coverage of excised burn wounds.

During the past 2 years a multicenter study was performed comparing Biobrane (Woodroof) and frozen cadaver allograft as temporary dressings on freshly excised full-thickness burns before the application of autograft. Each biologic dressing was evaluated with respect to the other on the same patient. Seventy-one patients were evaluated. The mean burn size was 35 +/- 20% with a mean full-thickness burn of 28 +/- 20%. Mean patient age was 34 +/- 21 years. Overall survival was 82%. The mean time of wound coverage was 10.2 +/- 6.7 days. There was no significant difference in the number of dressing changes, area changed, purulence, autograft take, and final results between allograft- and Biobrane-covered sites. There were no complications following use of either Biobrane or allograft. We conclude that Biobrane is as effective as frozen human cadaver allograft for the temporary coverage of freshly excised full-thickness burn wounds before autografting.

Adult↗
PubMed1985

The superficial musculoaponeurotic system in the upper lip: an anatomic study in cadavers.

Ten cadavers were employed to demonstrate the presence of the SMAS in the upper lip using macroscopic and microscopic techniques. The relationships and attachments of the SMAS to the dermis of the upper lip are described. In cadavers, medial traction on the SMAS in the upper lip in conjunction with superolateral traction on the SMAS in the cheek is found to decrease the depth of the nasolabial fold. Superior traction on the SMAS in the upper lip elevates the interlabial line, reestablishes the convexity of the lateral vermilion border, and partially increases concavity of the profile.

Adult↗
PubMed1988

Augmentation mammaplasty by cadaver fat allografts.

Two Soviet women were treated for complications of breast hardening and tenderness following augmentation mammaplasty using cadaver fat allografts. The cadaver fat grafts were excised and replaced with silicone-gel prostheses in the submammary pockets. The implants were found to contain necrotic fat tissue with areas of fibrosis and calcification; however, no signs of rejection were evident. Both patients had a successful postoperative outcome.

Adipose Tissue↗
PubMed1995

Total reconstruction of the alar cartilage en bloc using the ear cartilage: a study in cadavers.

To determine whether the lamina tragi, isthmus, and cavum conchae are a donor area for reconstruction of the alar cartilage with all its elements (medial crus, junction of the medial and lateral crura, and lateral crus), with the same dimension and en bloc, 40 alar cartilages and 40 lower parts of ear cartilages of 20 cadavers were dissected. Several measurements were taken in the alar cartilages, such as distance, thickness, and angle. Then they were compared with the measurements performed in the ear cartilages and segments removed from the lamina tragi, isthmus, and cavum conchae. This study, done with cadavers, shows that from the lamina tragi, isthmus, and cavum conchae, en bloc resection is possible with characteristics of form and dimension similar to those of the homolateral alar cartilage. The segment removed en bloc from the intermediate part of the lamina tragi, isthmus, and cavum conchae replaces, respectively, the medial crus, junction of the medial and lateral crura, and lateral crus.

Adult↗
PubMed1996

Minimally invasive harvesting of rectus abdominis myofascial flap in the cadaver and porcine models.

The rectus abdominis muscle has been used in reconstructive surgery as a superiorly and an inferiorly based pedicle flap as well as free flap. Since flap necrosis is unusual, the primary morbidity of the harvesting is donor-site complications, including infections, seromas, poor cosmesis, and hernias. Minimally invasive surgery has been used in abdominal, thoracic, and urologic surgeries with favorable results. To date, flap harvesting and other soft-tissue surgeries have been considered inaccessible to minimally invasive surgery based on existing techniques. We demonstrate in the (5) cadaver and (5) porcine models the technique of endoscopic harvesting of a superiorly based vertical myofascial pedicle flap. Without insufflation, we create a soft-tissue space to operate within using external skin traction. We demonstrate that this flap harvesting can be performed without the obligatory large skin incision. Donor-site complications may be decreased with less tissue disruption. In our cadaver models, we have tried using the rectus without the anterior fascia based on its superior pedicle for breast reconstruction. For this purpose, we use the endoscissors with cautery to create a tunnel up on the chest wall. The muscle based on its superior pedicle could be rotated up on the chest wall subcutaneously, allowing primary closure of the anterior sheath using the endostapler. If the anterior sheath is sacrificed or cannot be closed primarily, mesh can be used to create a reinforcing layer stapled to the edges of fascia and midline. Endoscopic surgery offers an excellent alternative for soft-tissue reconstruction without compromising the results.

Animals↗
PubMed1997

Sacroiliac motion for extreme hip positions. A fresh cadaver study.

STUDY DESIGN: This study placed fresh cadavers in different hip positions and obtained sacroiliac kinematics. The magnitudes and directions of angular and linear sacroiliac motion are reported. OBJECTIVES: To determine the three-dimensional motion at the left and right sacroiliac joints and to explore the mechanical structure of the sacroiliac joint. SUMMARY OF BACKGROUND DATA: Previous in vivo and in vitro studies have reported various amounts of motion at the sacroiliac joints, ranging from no motion to 18 degrees. The results of previous studies have typically not been reported as data in classic engineering terms, and three-dimensional analyses are sparse. Importantly, previous studies have not used external hip positions to elucidate the full range of sacroiliac motion. METHODS: Radiopaque markers were placed in the sacrum and each innominate bone before standardized performance of computed tomography scans at 3-mm intervals, with the fresh cadaver stabilized in the side-lying position on a specially constructed pallet. Computed tomography images were stored on magnetic tape, from which coordinates for centroids of the markers were obtained and subsequent mechanical analyses performed. The intersubchondral lines on the images were traced and reconstructed using computer technology to obtain the thickness of the intersubchondral joint space and the general configuration of the sacroiliac joints. RESULTS: The methods used in this study were validated. The largest amount of sacroiliac motion occurred in the sagittal plane (7 degrees on left and 8 degrees on the right, with a range of 3 degrees to 17 degrees). Definite trends in the direction of angular sacroiliac motion occurred with respect to both bilateral and reciprocal hip joint positions. The translation or linear motion of the posterior superior iliac spines with respect to the sacrum ranged from 4 to 8 mm. This motion tended to occur in all directions, with no detectable trends. The average intersubchondral thickness of the sacroiliac joint was 1.2 mm and the shape of the joint resembled that of an airplane propeller. CONCLUSIONS: Even though the subjects in this study were elderly, considerable angular and linear motion was in evidence. As such, it appears that extreme hip positions are necessary to elucidate full range of motion at the sacroiliac joint. The magnitude and direction of demonstrated sacroiliac motion appears to be sufficient to complement hip joint motion and influence motion at the lumbosacral junction and, thus, low back pain in both the direct and indirect sense.

Aged↗
PubMed1975

The fate of cadaver renal allografts contaminated before transplantation.

Through the routine use of cultures from saline slush transport solution and the initial and final organ perfusates, 14 of 81 cadaver allografts (17.3%) were found to have been contaminated before transplantation. Gram negative organisms, cultured from 5 of the 14 contaminated allografts, resulted in the recipient's death on the first encounter with this problem and the loss of two other allografts. Early antibiotic therapy begun even without evidence of overt infection appeared to prevent any further deaths or graft loss in those whose allografts were contaminated and yielded an overall survival comparable to that of uncontaminated allografts. Without such an approach to the study of perfused cadaver allografts and the management of them when found to be contaminated, this type of infection may go undetected and contribute to allograft and patient loss.

Adolescent↗
PubMed1983

A controlled randomized double-blind study of antilymphoblast globulin in cadaver renal transplantation.

Herein are presented the results of a controlled prospective randomized double-blind evaluation of antilymphoblast globulin as an immunosuppressive adjunct to azathioprine and prednisone in cadaver renal transplantation. There were 31 patients and 36 patients randomly assigned to therapeutic and control groups, respectively. ALG-treated patients experienced no major side-effects, a delayed onset of rejection following transplantation (P less than .005), a reduced total number of rejection episodes (P less than .05), fewer days in the hospital (P less than .05), a reduced cost of transplantation (P less than .02), improved graft survival (P less than .05), and patient survival equivalent to that of the control group. These data indicate that ALG is safe, cost-effective, and of immunologic benefit in cadaver renal transplantation.

Adult↗
PubMed1985

Successful cadaver kidney transplantation in patients highly sensitized by blood transfusions. Unimportance of the most reactive serum in the pretransplant crossmatch.

Six patients who underwent a prospective blood transfusion protocol developed antibodies reactive with 41-95% of a lymphocyte panel. These antibodies disappeared 9-18 months later, and all six patients were successfully transplanted with cadaver kidneys in spite of positive crossmatches with donor T and B cells using their most reactive noncurrent sera. Crossmatches with their current sera were negative. No patient underwent plasmapheresis, blood transfusions, or immunosuppression between the time of maximum panel reactivity and transplantation. Graft survival was 100% after a mean of 22.3 months, and the mean serum creatinine level was 2.1 mg/dl one year after grafting. A positive anti-donor T or warm B cell crossmatch with the most reactive serum may be disregarded if the most recent serum is crossmatch-negative with a cadaver kidney transplant donor.

Adult↗
PubMed1988

Factors influencing early renal function in cadaver kidney transplants. A case-control study.

We performed a multicenter study to investigate the problem of cadaver kidney transplants that never achieve function, or that recover after a period of delayed function, and we used multivariate techniques to model the results. Sixty-nine patients who received cadaver kidney transplants that never functioned (NF) were compared with 69 kidney recipients with early graft function (EF), and 69 with delayed but recovering graft function (DF), matched for transplant hospital and time. The results were analyzed using an unconditional logistic regression model. Risk factors for never-function transplants compared to immediate-function transplants were as follows: previous failed transplant, no polyclonal antilymphocyte globulin (ALG) prophylaxis, increasing anastomosis time, decreasing donor blood pressure, and prior transfusions in first but not subsequent transplant recipients. When technical failures were excluded, 88% of NF grafts displayed severe rejection, suggesting that rejection in a poorly functioning kidney is the principal cause of the NF outcome. Risk factors for delayed function compared to immediate function were these: increasing anastomosis time, no ALG, increasing total cold ischemia time, duration of end-stage renal disease (ESRD), and male sex. Thus ischemic and immunologic risk factors contributed to the DF and NF outcomes. This study suggests that efforts to reduce the delayed and never-function outcomes should be directed to the use of ALG prophylaxis and to the reduction of cold ischemia and anastomosis times, particularly in recipients who have lost a previous transplant.

Adolescent↗
PubMed1990

Influence of cadaver donor age on posttransplant renal function and graft outcome.

To assess the impact of cadaver donor age on posttransplant renal function and graft survival, we analyzed our clinical results in 17 recipients of younger donor kidneys (less than 10 years) and 48 recipients of older donor kidneys (greater than 50 years) and compared them with a control group of 598 patients who received kidneys from donors between 11 and 50 years of age. The 3 groups were comparable with respect to recipient age, duration of dialysis, prior transfusions, previous transplants, cold ischemia time, HLA AB mismatches, cytotoxic antibody profile, posttransplant ATN, and prophylactic ALG treatment. The cumulative patient survival at 1, 2, and 3 years was not significantly different among the 3 groups, but the graft survival in recipients of older donor kidneys was significantly lower than the control (71% vs. 62% at 2 years, P = .09 and 66% vs. 55% at 3 years, P = .0003. The short-term renal function assessed at 1 month posttransplant was significantly lower in the older donor group compared with the control (creatinine clearance 45 mL/min vs. 59 mL/min, P = .0003). Likewise, the long-term renal function assessed at the last follow-up was also lower in the older donor group than the control (creatinine clearance 40 mL/min vs. 49 mL/min, P = .07). There were no significant differences in graft survival or short- or long-term renal function between the younger donor group and the control group. These observations suggest that transplantation of a kidney from an older cadaver donor is associated with an inferior posttransplant outcome. The practical decision whether or not to use an older donor kidney should be individualized taking this as well as other factors into account.

Adolescent↗