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At least 433 records · Page 24Linked to original sources
PubMed2000

The scaphotrapezio-trapezoidal joint. Part 1: An anatomic and radiographic study.

To evaluate anatomic variations and distribution of degenerative changes in the scaphotrapezio-trapezoidal (STT) joint, 165 embalmed cadaver wrists were examined. An interfacet ridge on the distal scaphoid was found in 81% of the wrists and the shape of the distal joint surface of the scaphoid was classified into 3 types. Underdevelopment of the capitate-trapezium ligament was found in 15% of the wrists. A new skeletal measurement for the inclination of the joint surface of the trapezium-trapezoid in the STT joint (TT inclination) was investigated anatomically and radiographically. Degenerative changes were found in 39% of the wrists. The most common location of degenerative changes was on its ulnar aspect on the distal scaphoid and on the radial and central aspect of the trapezoid on the TT side. The presence of degenerative changes had a significant correlation with a higher anatomic and/or radiographic TT inclination and/or underdevelopment of the capitate-trapezium ligament.

Adult↗
PubMed2001

Type I versus type II lunates: Ligament anatomy and presence of arthrosis.

One hundred-seventy embalmed cadaver wrists were dissected. The type of lunate (type I, no medial hamate facet; type II, medial hamate facet), the incidence and location of arthrosis (exposed subchondral bone) in the lunohamate joint, and the anatomic relationship of the volar triquetrocapitate (T-C) and the volar triquetrohamate (T-H) ligaments were identified and measured. The relationship between the T-C and T-H ligaments was classified into 3 types. In type A the T-C ligament was completely separate from the T-H ligament, in type B the T-C ligament overlapped the T-H ligament, and in type C the T-C ligament had an additional ligament from the triquetrum to the proximal pole of the hamate. Eighty-two percent of type I lunates were associated with a type A relationship between the T-C and the T-H ligaments and 96% of type II lunates were associated with a type C relationship between the T-C and the T-H ligaments. Arthrosis at the proximal pole of the hamate was more commonly associated with the type II lunates (49%) and with the type C relationship (57%) of the T-C and T-H ligaments. The incidence of arthrosis in the lunohamate joint was also significantly greater in the type II lunate with a medial facet of 3 mm or more.

Adult↗
PubMed2002

The anatomical and neurophysiological basis of the sensate free TRAM and DIEP flaps.

Recent developments in autogenous breast reconstruction using the rectus abdominis myocutaneous free flap include attempts to reinnervate the flap tissue. We have carried out anatomical studies to determine the nature of abdominal-wall cutaneous innervation, with particular emphasis on the harvesting of sensate flaps. Dissections were performed on four embalmed and 12 fresh human cadavers (32 sides). The lowest five intercostal nerve trunks were identified and traced to the lateral border of the rectus sheath. A detailed dissection of the intramuscular course of the nerves and associated vasculature was performed. The relationship of the nerves to the vascular perforators used for rectus abdominis myocutaneous flaps was determined visually, and confirmed histologically. In contrast to previous studies, we show that nerves supplying cutaneous sensation can travel with both medial and lateral vascular perforators. In order to confirm clinically useful innervation, the abdominal flap skin of five patients undergoing TRAM flap reconstruction was stimulated electrically, and sensory recordings were made directly from the related intercostal nerve just prior to flap harvest. These studies represent, to our knowledge, the first clinical application of neurophysiological techniques to outline the perforator neurosomes of flaps based on the deep inferior epigastric vascular axis. We provide the first comprehensive study of abdominal-wall innervation with regard to sensate free-flap harvest. Our dissections show complex patterns of abdominal skin innervation that have not been previously described. The implications for sensate free TRAM and DIEP flap reconstructions, as well as the potential for more accurate inclusion of innervated flap skin, are discussed.

Abdominal Muscles↗
PubMed2002

Scapular position: the validity of skin surface palpation.

The assessment of the resting position of the scapula forms part of the examination of upper quadrant posture. The purpose of this study was to determine if surface palpation is a valid indicator of actual scapular position. Twelve embalmed shoulders were examined and the actual location of three bony scapular landmarks and three bony thoracic landmarks were compared with surface palpation of these locations. The results, based on the upper value for a distance (with 95% confidence), suggested that the difference between the surface location of the root of the spine of the scapula, the acromial angle and the inferior angle would be less than 0.67 cm, 0.98 cm and 0.46 cm respectively from the centre of the bony locations. The difference between the twelfth thoracic spinous process (SP), the SP corresponding with the root of the spine of the scapula, and the SP corresponding with the inferior angle and the surface points would be 1.46 cm, 1.09 cm and 1.01 cm respectively. The results of this study suggest that surface palpation of scapular location is a valid method for determining the actual location of the scapula. The findings also suggest that surface palpation can determine the location of thoracic landmarks, which may serve as reference points for scapular position.

Aged↗
PubMedDate not supplied

[Measurements of the deformation of the femur using speckle interferometry].

A new method for measuring the surface displacement in bones is described. Speckle interferometry was used to study the deformation behaviour of embalmed human femoral bones. The bones were measured under varying loads and conditions. It was shown that the magnitude and direction of displacement could be ascertained at selected points and the strain between any two points could be calculated. The present findings differ from those derived from mathematical models for the femoral bone published so far. The practicability of this technique is outlined. The present results indicate that the technique of speckle interferometry can also be applied to femoral bones with prostheses or external fracture fixations.

Biomechanical Phenomena↗
PubMed1999

A novel endoscopic approach to anterior odontoid screw fixation: technical note.

Techniques for operative management for type II odontoid fractures have continuously been refined with anterior odontoid screw arthrodesis having a clear advantage in maintaining normal motion. We have refined the technique of odontoid screw fixation further with the introduction of an endoscopic approach developed by the senior author. The necks of two partially embalmed cadavers were slightly extended under fluoroscopic guidance to simulate a reduced, anteriorly displaced type II fracture. Using a guide wire, graduated plastic sheath and endoscopic guidance, a solid 45 mm bone screw was passed through the odontoid with the aid of biplanar fluoroscopy. There were no apparent complications and no damage to surrounding vital structures. Anterior screw fixation of the odontoid is an established technique that provides adequate fixation, but the procedure can be technically demanding secondary to awkward tissue retraction. We present a percutaneous technique that obviates the need for tissue retraction while achieving an excellent result with only a modicum of effort.

Arthroscopy↗
PubMed1998

Anatomo-radiological evaluation of lateral approaches to the skull base.

Our objective is to correlate the anatomical exposure provided by complex skull base approaches to the lateral skull base with their CT and MRI scans counterparts and to introduce a modular concept emphasizing the derivation of complex skull base approaches from simpler ones.We executed 10 lateral approaches to the skull base in 20 embalmed cadaveric heads (40 sides). Each approach was executed a minimum of three times on each specimen. These approaches were the pterional and its modifications, the subtemporal and its modifications, and the suboccipital and its modifications. We correlated the approaches and the areas of the skull base exposed by scanning the surgical cavity filled with material imageable by CT and MRI and throughly surveying the operative field.Visualization of the area of the skull base exposed was excellent using our CT-MRI imageable cadaveric preparation. The topographic areas of the skull base exposed correlated well with their radiological counterparts.The areas of the skull base exposed by each of the complex surgical approaches to the skull base were clearly delineated by using our anatomo-radiological correlation. Complex approaches to the skull base are formed by simple neurosurgical approaches (building blocks) to which different modules are added.

Journal Article↗
PubMed1997

Interactive image guidance in skull base surgery using an opto-electronic device.

The applicability of an image guidance frameless system based on an opto-electronic sensor device in skull base surgery was explored in this study. Five embalmed heads with external fiducial markers placed in noncoplanar points were scanned (CT scan) and different skull base approaches were reproduced in these specimens. The opto-electronic system is comprised of an infrared camera, a local rigid body, and a 24-light-emitting diode probe attached to different surgical instruments. DOS-based calibration and transformation software and Unix-based surgical planning software were also used. The anatomic landmarks identified during the dissection were matched with the corresponding points derived from computed tomographic (CT) scans. This information allowed the surgeon to develop a three-dimensional representation of the surgical field and to anticipate the next anatomic structure encountered during the dissection. This infrared device operated in real time, is not affected by external factors with regard to its accuracy, and does not interfere with standard neurosurgical techniques. This frameless system is helpful in minimizing the risk of morbidity and provides an accurate guide during the approach, as well as unobstructed access to the surgical field.

Journal Article↗
PubMed2006

Formaldehyde exposure in a gross anatomy laboratory--personal exposure level is higher than indoor concentration.

GOAL, SCOPE AND BACKGROUND: Cadavers for gross anatomy laboratories are usually prepared by using embalming fluid which contains formaldehyde (FA) as a principal component. During the process of dissection, FA vapors are emitted from the cadavers, resulting in the exposure of medical students and their instructors to elevated levels of FA in the laboratory. The American Conference of Governmental Industrial Hygienists (ACGIH) has set a ceiling limit for FA at 0.3 ppm. In Japan, the Ministry of Health, Labour and Welfare has set an air quality guideline defining two limit values for environmental exposure to FA: 0.08 ppm as an average for general workplaces and 0.25 ppm for specific workplaces such as an FA factory. Although there are many reports on indoor FA concentrations in gross anatomy laboratories, only a few reports have described personal FA exposure levels. The purpose of the present study was to clarify personal exposure levels as well as indoor FA concentrations in our laboratory in order to investigate the relationship between them. METHODS: The gross anatomy laboratory was evaluated in the 4th, 10th and 18th sessions of 20 laboratory sessions in total over a period of 10 weeks. Air samples were collected using a diffusive sampling device for organic carbonyl compounds. Area samples were taken in the center and four corners of the laboratory during the entire time of each session (4-6 hours). Personal samples were collected from instructors and students using a sampling device pinned on each person's lapel, and they were 1.1 to 6 hours in duration. Analysis was carried out using high performance liquid chromatography. RESULTS AND DISCUSSION: Room averages of FA concentrations were 0.45, 0.38 and 0.68 ppm for the 4th, 10th and 18th sessions, respectively, ranging from 0.23 to 1.03 ppm. These levels were comparable to or relatively lower than the levels reported previously, but were still higher than the guideline limit for specific workplaces in Japan and the ACGIH ceiling limit. The indoor FA concentrations varied depending on the contents of laboratory sessions and seemed to increase when body cavity or deep structures were being dissected. In all sessions but the 4th, FA levels at the center of the room were higher than those in the corners. This might be related to the arrangement of air supply diffusers and return grills. However, it cannot be ruled out that FA levels in the corners were lowered by leakage of FA through the doors and windows. Average personal exposure levels were 0.80, 0.45 and 0.51 ppm for instructors and 1.02, 1.08 and 0.89 ppm for students for the 4th, 10th and 18th session, respectively. The exposure levels of students were significantly higher than the mean indoor FA concentrations in the 4th and 10th sessions, and the same tendency was also observed in the 18th session. The personal exposure level of instructors was also significantly higher than the indoor FA level in the 4th session, while they were almost the same in the 10th and 18th sessions. Differences in behavior during the sessions might reflect the differential personal exposure levels between students and instructors. CONCLUSION: The present study revealed that, if a person is close to the cadavers during the gross anatomy laboratory, his/her personal exposure level is possibly 2 to 3-fold higher than the mean indoor FA concentration. This should be considered in the risk assessment of FA in gross anatomy laboratories. RECOMMENDATION AND OUTLOOK: If the risk of FA in gross anatomy laboratories is assessed based on the indoor FA levels, the possibility that personal exposure levels are 2 to 3-fold higher than the mean indoor FA level should be taken into account. Otherwise, the risk should be assessed based on the personal exposure levels. However, it is hard to measure everyone's exposure level. Therefore, further studies are necessary to develop a method of personal exposure assessment from the indoor FA concentration.

Air Pollution, Indoor↗
PubMed2002

Biomechanical influences of magnetic resonance imaging on the SOUNDTEC Direct System implant.

OBJECTIVE: The purpose of this study was to measure the forces experienced by the SOUNDTEC Direct System magnetic implant during 0.3-T MRI. STUDY DESIGN: Torsional and linear forces imposed on 8 implants were measured by using calibrated neurologic Von Frey hairs and were compared with finite-element analysis predictions and the forces required to separate the incudostapedial joints of unpreserved temporal bones. An implanted embalmed autopsy specimen was also examined before and after 1.5-T MRI. RESULTS: Peak linear force at the orifice of the MRI core measured 0.51g (+/-0.2 SD). Maximum torque occurred at the MRI core center and measured 11.4g-cm (+/-1.2 SD). The mean torque required to separate the incudostapedial joints of 12 unpreserved temporal bones was 33.8g-cm (+/-20.4 SD). The autopsy specimen sustained a 1.5-T MRI scan without disruption of the ossicular chain or explantation. CONCLUSIONS: Physical and mechanical testing of the SOUNDTEC implant indicates that the structural integrity of the ossicles will be maintained during 0.3-T MRI of the human head.

Biomechanical Phenomena↗
PubMed2001

Attachment of the rectovaginal septum to the pelvic sidewall.

OBJECTIVE: To describe the lateral attachment of the rectovaginal fascia to the pelvic sidewall. STUDY DESIGN: A descriptive study was performed with use of 10 embalmed female cadaveric pelves, each sectioned in the midsagittal plane. The lateral attachments of the pubocervical fascia and the rectovaginal fascia to the pelvic sidewall were examined. RESULTS: The rectovaginal fascia attaches to the pelvic sidewall along a well-defined line. It extends from the perineal body toward the arcus tendineus fasciae pelvis with which it converges approximately midway between the pubis and the ischial spine to form a y configuration. This point of convergence occurs an average of 4.8 cm from the ischial spine, 3.75 cm from the pubic symphysis, and 4.15 cm from the posterior fourchette. CONCLUSION: The rectovaginal fascia supports the posterior compartment analogous to the pubocervical fascia in the anterior compartment. Moreover, landmarks are identified that will aid suture placement during repair of posterior compartment defects.

Cadaver↗
PubMedDate not supplied

Anterior and posterior musculotendinous anatomy of the supraspinatus.

The objective of this study was to quantitatively describe the supraspinatus musculotendinous architecture. After supraspinatus muscles were harvested from 25 embalmed shoulders, each muscle was divided into an anterior and posterior muscle belly on the basis of muscle fiber insertion. Pennation angles and musculotendinous dimensions were measured, and the physiologic cross-sectional area was calculated for each muscle belly. The physiologic cross-sectional areas of the anterior and posterior bellies were calculated to be 140 +/- 43 mm2 and 62 +/- 25 mm2, respectively, whereas their tendon cross-sectional areas were 26.4 +/- 11.3 mm2 and 31.2 +/- 10.1 mm2, respectively. The average anterior-to-posterior ratios for the muscle physiologic cross-sectional area and the tendon cross-sectional area were 2.45 +/- 0.82 and 0.87 +/- 0.30, respectively. Thus, a larger anterior muscle pulls through a smaller tendon area. These data suggest that physiologically, anterior tendon stress is significantly greater than posterior tendon stress and that rotator cuff tendon repairs should incorporate the anterior tendon whenever possible, inasmuch as it functions as the primary contractile unit.

Aged↗
PubMedDate not supplied

The kinematic elbow axis as a parameter to evaluate total elbow replacement: A cadaver study of the iBP elbow system.

Malpositioning of prosthetic implants leads to biomechanical changes, often resulting in deteriorating functional outcome. This emphasizes the relevance of evaluating the surgical process of inserting the prostheses. This study tested to what extent the iBP elbow prosthesis and its alignment tools enabled a surgeon to reconstruct normal joint kinematics. It demonstrates the use of the kinematic elbow axis as an evaluation tool. An electromagnetic tracking device registered controlled passive elbow flexion of 10 embalmed upper extremities. The position and direction of the preoperative and postoperative kinematic elbow axes were established with the use of helical axes and compared. The postoperative position of the elbow axis differed from the preoperative axis because of limitations of the alignment tools. Suggestions for adjustment of the alignment tools are made. The direction of the imposed resection plane was correct; therefore, the direction of the postoperative elbow axis corresponded with the direction of the preoperative axis.

Arthroplasty, Replacement↗
PubMed2001

Frontal sinus outflow tract "anatomic study".

Meticulous anatomical knowledge is mandatory to approach endoscopically the frontal sinus area safely and manage its diseases successfully. The aim of this study was to identify the various drainage patterns of the frontal sinus. To illustrate these patterns we performed anatomical dissections of the outflow tract of the frontal sinus in 30 cadaver half heads. We found that the frontal sinus drained anterior to the uncinate process in 23.3% of specimens and posterior to it in 63.3%, while it drained medial to the semilunar hiatus in 6.6%. Our study, however, represents an exclusive assortment of linear and angular measurements of important landmarks around the frontal recess region. Although these measurements were made in embalmed tissue, we believe they will provide reference points in endoscopic sinus surgery.

Endoscopy↗
PubMedDate not supplied

Drug use among Texas alternative school students: findings from Houston's Safer Choices 2 Program.

Self-report drug use data were collected from 494 alternative school students, grades seven through 12, surveyed through the Safer Choices 2 study in Houston, Texas. Data were collected between October 2000 and March 2001 via audio-enabled laptop computers equipped with headphones. Twenty-eight percent of the sample reported past-month marijuana use, and 10% reported past-month opiate/codeine use. Males were almost twice as likely as females to have used cocaine during the past month, and over four times as likely to have used opiates/codeine during the past month. Students 16 years and older and were twice as likely to have ever used cocaine and opiates/codeine than students under 16 years. Latinos were 10 times more likely than Blacks to have ever used cocaine; Blacks were twice as likely as Latinos to have used opiates/codeine during the past month. Males were twice as likely as females to have tried "fry," a new street drug made of tobacco or marijuana mixed with embalming fluid and PCP. These new drug trends are startling because they indicate a potential for long-term treatment services for abusers.

Adolescent↗
PubMed2004

Anatomical study of subcutaneous adipofascial tissue: a concept of the protective adipofascial system (PAFS) and lubricant adipofascial system (LAFS).

The subcutaneous adipofascial tissue over the entire body was radiographically and macroscopically investigated in 20 fresh and embalmed cadavers. The subcutaneous adipofascial tissue was made up of two adipofascial layers. Because the superficial layer forms a solid structure and is thought to protect against external forces, the adipofascial system formed by the solid structure was named the "protective adipofascial system (PAFS)". Because the deep layer forms a mobile layer and is thought to lubricate musculoskeletal movement, the adipofascial system formed by the mobile structure was named "lubricant adipofascial system (LAFS)". By classifying subcutaneous adipofascial tissue by its functional characteristics, we found we could understand the subcutaneous adipofascial structure over the entire body well.

Adipose Tissue↗
PubMed2001

Characterizing formaldehyde emission rates in a gross anatomy laboratory.

The evaporation of formaldehyde from cadavers in gross anatomy laboratories can produce high exposures among students and instructors. To understand the system that produces exposures and to plan for implementing control options, the generation of formaldehyde vapors must be characterized. A gross anatomy laboratory with 47 dissecting tables was studied during 15 lab sessions over a period of 16 weeks. Area concentrations were measured using National Institute of Occupational Safety and Health (NIOSH) method 3500. Average daily area concentrations in the laboratory ranged from 0.635 to 1.82 mg/m3. The ventilation was characterized on three separate days. The laboratory had a general ventilation rate of 9.8 air changes per hour. There was no local exhaust ventilation. The concentration measurements were used in a mass balance model along with ventilation rates to determine formaldehyde emission rates. The daily average formaldehyde emission rate from all sources in the laboratory ranged from 95.2-274 mg/min, with an average of 148 mg/min over the course of the study. This total emission rate was used along with the number of dissecting tables to develop an emission factor of 3.15 mg/min per table. The emission factor is a generalizable tool that can be used in laboratories of various sizes to predict emission rates and develop control strategies. This emission factor is applicable where the cadavers are prepared with similar embalming fluid consisting of approximately 10 percent formaldehyde.

Air Pollutants, Occupational↗
PubMed2005

Cross-sectional area of the tendon and the muscle of the biceps brachii in shoulders with rotator cuff tears: a study of 14 cadaveric shoulders.

BACKGROUND: The intraarticular portion of the long head of the biceps tendon is often widened in shoulders with cuff tears. It is unclear whether this is a local phenomen or is caused by muscle hypertrophy. METHODS: We investigated morphological changes of the biceps brachii in 14 embalmed shoulders: 7 with intact rotator cuff and 7 with rotator cuff tears. We measured the cross-sectional area (CSA) of the tendon of the long head of the biceps (LHB) at 9 levels between the glenoid origin and the musculotendinous junction. The muscle volume and the muscle fiber length of the long and short heads of the biceps were measured to calculate the physiological CSA (PCSA) by dividing the volume by the fiber length. RESULTS: The CSA of the LHB tendon at the entrance to the bicipital groove was greater in cuff tear shoulders than in normal shoulders. The PCSA of the biceps was similar in normal and cuff tear shoulders. INTERPRETATION: Hypertrophy of the LHB tendon appears to be a localized morphological change near the entrance to the bicipital groove.

Aged↗