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PubMed1986

Lumbrical length changes in finger movement: a new method of study in fresh cadaver hands.

A new method of loading the lumbrical muscle in the cadaver hand, based on the bicycle brake cable concept, has been developed. The device can be inserted with the aid of tendon-tunneling forceps and sutured to the profundus tendon at the origin of the lumbrical muscle. Lumbrical function is stimulated by applying a force that approximates the attachment point on the profundus tendon to the lateral wing of the extensor expansion without predetermining which will move the origin, the insertion, or both. This preliminary study reports the use of this device in determining lumbrical length changes in five fresh cadaver hands as the index finger was passively moved through each of six standard finger positions. In the absence of other restraints lumbrical contraction causes the index finger to move from the claw position through the straight to the intrinsic position. The latter position represents maximum shortening.

Adult↗

PubMed2001

Forced oral opening for cadavers with rigor mortis: two approaches for the myotomy on the temporal muscles.

Forensic dentistry plays an essential role in personal identification procedures. An adequate interincisal space of cadavers with rigor mortis is required to obtain detailed dental findings. We have developed intraoral and two directional approaches, for myotomy of the temporal muscles. The intraoral approach, in which the temporalis was dissected with scissors inserted via an intraoral incision, was adopted for elderly cadavers, females and emaciated or exhausted bodies, and had a merit of no incision on the face. The two directional approach, in which myotomy was performed with thread-wire saw from behind and with scissors via the intraoral incision, was designed for male muscular youths. Both approaches were effective to obtain a desired degree of an interincisal opening without facial damage.

Adult↗

PubMed2001

Using medical lubricating jelly in human cadaver eyes to teach ophthalmic surgery.

Attempting to learn phacomemulsification through the severely edematous cornea of a human cadaver eye is often difficult. We propose a method of improving the view of the anterior chamber structures. Medical lubricating jelly is injected into the anterior chamber of a cadaver eye. After 10 minutes, excellent corneal clarity is achieved. There was no change in the corneal edema with the injection of sodium hyaluronate 1.4% (Healon GV as a control. Using medical lubricating jelly in place of viscoelastic material is an inexpensive, effective adjunct in ophthalmic surgical teaching.

Anterior Chamber↗

PubMed1990

Histologic and morphologic effects of rotary atherectomy on human cadaver arteries.

Intimal splitting and medial dissection caused by balloon angioplasty and thermal burns and subintimal vacuolization caused by laser angioplasty have been proposed as potential causes of failure from these respective procedures. The purpose of this study was to evaluate the histologic and morphologic effects of a new high speed rotary atherectomy device (the Rotoblator) on human cadaver arteries. Fifteen stenotic human cadaver superficial femoral and popliteal arteries were harvested and atherectomized using the Rotoblator. Histologically, on cross-section, the atherectomized arteries exhibited a denuded endothelial layer, a smooth rounded luminal contour, minute plaque separation from the media, absence of plaque fragmentation, and variable remaining rim of atheromatous plaque. The media showed variable loss of the internal elastic lamina, normal remaining elastin, and normal smooth muscle cells. The adventitia was normal and completely intact in all sections with no media/adventitia separation or perforations. Scanning electron microscopy revealed endothelial peeling, etching from the atherectomy devices within the smooth muscle layer, and a tapered atherectomy distal endpoint. The arterial branches were preserved without evidence of any disruption of the branch artery orifice. Compared to balloon angioplasty and laser angioplasty, the Rotoblator atherectomy device appears to leave a smoother, more rounded luminal surface that may result in less risk of embolic complications and arterial wall damage.

Angioplasty, Balloon↗

PubMed1998

Endoscopic axillary lymph node dissection: an experimental study in human cadavers.

BACKGROUND: The role of axillary lymph node dissection in the staging of patients with breast carcinoma is currently under evaluation. As a result of recent advances in minimally invasive techniques, an endoscopic approach to axillary lymph node dissection may be an attractive alternative to lymphadenectomy performed via a standard "open" axillary incision. The purpose of the present study was to evaluate the technical feasibility and safety of such an approach in human cadavers. STUDY DESIGN: Twelve axillary dissections (right in seven, left in five) were performed in seven cadavers. A 2.5-cm incision was made along the lateral chest wall 12 cm inferior to the apex of the axilla. The subcutaneous axillary space was expanded with a balloon dissector, and exposure was maintained with a prototype external lift device. Endoscopic dissection was performed with three or four 5-mm ports inserted into this space. Histologic analysis was performed to document the number of lymph nodes removed. RESULTS: The mean dissection time for endoscopic axillary lymphadenectomy was 56.7+/-19 minutes (range, 30-90 minutes). Structures visualized endoscopically included the axillary vein (12 of 12 patients), the long thoracic nerve (12 of 12 patients), the thoracodorsal nerve (10 of 12 patients), and the intercostobrachial nerve (11 of 12 patients). An average of 9.9+/-7.2 lymph nodes (range, 2-22 nodes) was removed from each axilla. Open exploration of the axilla after the endoscopic dissection confirmed no injuries to any neurovascular structures. Residual lymph nodes were removed from the axilla in 7 of 12 dissections (58%; average, 4.2+/-4.0 nodes per specimen). CONCLUSIONS: These results suggest that endoscopic axillary dissection is feasible with currently available technology. Clinical trials in patients with breast carcinoma may be warranted to evaluate this technique further.

Axilla↗

PubMed1998

Comparison of magnetic resonance imaging and gross findings regarding masseter muscle aponeuroses in cadavers.

OBJECTIVES: The main objective of this study was to compare the actual distribution and thickness of aponeuroses in cadavers with the distribution and thickness as determined by means of magnetic resonance imaging for the sake of evaluating magnetic resonance imaging as a diagnostic modality for assessing masseter muscle aponeuroses. STUDY DESIGN: The aponeuroses of 26 masseter muscles from 13 intact cadavers were examined by magnetic resonance imaging. RESULTS: The ratio of concordance between gross findings and magnetic resonance imaging findings was 99.0%, although depiction of thin parts of the aponeuroses on magnetic resonance imaging was poor. CONCLUSIONS: Magnetic resonance imaging was useful as a diagnostic modality in the assessment of masseter muscle aponeuroses. Aponeuroses were distributed throughout almost the entire masseter muscle, although almost no aponeuroses were seen below the lower half of the anterior margin. This was thought to be a characteristic finding of masseter aponeuroses.

Aged↗

PubMed2000

A catheter technique in ophthalmic regional anaesthesia. Cadaver experiments.

BACKGROUND: Regional anaesthesia for ophthalmic surgery is generally accomplished by peri- or retrobulbar techniques. Depending on the duration of ophthalmic surgery, reblock might become necessary. Our goal was to invent a catheter technique for ophthalmic regional anaesthesia that enables the user to administer local anaesthetics intraoperatively into the peri- or retrobulbar space continuously. METHODS: Twenty-five adult cadaver orbits of normal size and anatomy were used for the experiments. A flexible catheter was introduced transcutaneously or transconjunctivally into the extra- or intraconal space. Methylene blue solution was injected through the catheter. RESULTS: Using the same transcutaneous retro- and peribulbar technique, it was possible to introduce flexible catheters into a proper position of the cadaver orbits. The injected dye was found intra- or extraconally. CONCLUSION: Examining the spread of the dye in the orbit, we concluded that it is possible to provide ophthalmic anaesthesia for surgery through an indwelling catheter. We proved that continuous or intermittent administration of a local anaesthetic agent into the extra- or inraconal space can be achieved and this technique may allow us to maintain anaesthesia as long as it is necessary.

Anesthesia, Conduction↗

PubMed1997

A comparative study of removal torque of endosseous implants in the fibula, iliac crest and scapula of cadavers: preliminary report.

This study was undertaken to compare removal torque of endosseous implants in the fibula, iliac crest and scapula of cadavers. The fibulae, iliac crests and scapulae were harvested from the right side of 5 formalin-preserved cadavers. Endosseous implants (Brånemark System) were placed at 3 points of each bone. The removal torque of the implant was measured by a torque gauge manometer (Tohnichi 15 BTG-N). After measurement of the removal torque, the bone was cut at each implant site. The thicknesses of cortical and total bone were measured. The mean removal torques were 46.3 N cm in the fibulae, 15.2 N cm in the iliac crests and 21.4 N cm in the scapulae. There was a statistically significant difference in mean removal torque between the three bones. The total bone thicknesses were 11.7 mm in the fibulae, 9.9 mm in the iliac crests and 8.2 mm in the scapulae. The cortical bone thicknesses were 5.0 mm in the fibulae, 1.6 mm in the iliac crests and 1.8 mm in the scapulae. Significant correlation between the removal torque and the cortical bone thickness was found. However there was no significant correlation between the removal torque and the total bone thickness. In conclusion, the implants inserted in the fibulae showed the highest removal torques as compared to the ones inserted in the iliac crests and the scapulae. Moreover the removal torque was related to the thickness of the cortical bone in the implant sites.

Adult↗

PubMed2000

Anatomic characteristics of the infraorbital foramen: a cadaver study.

PURPOSE: The aim of this study was to document the variability in the position of the infraorbital foramen with relation to the facial midline, infraorbital rim, supraorbital notch, and maxillary teeth. MATERIALS AND METHODS: Forty-seven cadavers (94 sides) were dissected, exposing the infraorbital foramen, supraorbital foramen, and orbital floor bilaterally. Measurements made included (A) distance between the infraorbital foramen and inferior orbital rim; (B) distance of the infraorbital foramen from the facial midline; (C) distance of the supraorbital foramen from the facial midline; (D) distance between the infraorbital foramen and supraorbital foramen. Means, standard deviations, and ranges were determined, and statistical differences were calculated between the left and right orbits and sexes by use of an unpaired sample t-test (P < .05). RESULTS: In men, the mean distance between the infraorbital foramen and the inferior orbital rim was 8.5 +/- 2.2 mm. In women, this was 7.8 +/- 1.6 mm. The distance between the infraorbital foramen from the facial midline was 27.7 +/- 4.3 mm in males and 26.2 +/- 3.2 mm in females. The mean distance between the infraorbital foramen and supraorbital notch in males was 43.3 +/- 3.1 mm and in females was 42.2 +/- 2.4 mm. The average distance of the supraorbital notch from the midline was 26.5 +/- 3.5 mm in males and 26.3 +/- 3.3 mm in females. There were no statistically significant differences between the left and right sides or between sexes. The maxillary tooth most commonly found in the same vertical plane as the infraorbital foramen was the first premolar. Multiple ipsilateral foramina were found in 15% of cadavers. CONCLUSION: These anatomic characteristics may have important implications for surgical and local anesthetic planning.

Cephalometry↗

PubMed1999

Flexor tendon repair using a stainless steel external splint. Biomechanical study on human cadaver flexor tendons.

A stainless steel external tendon splint was used in repair of cadaver tendons and compared with standard tendon repairs with suture. The splint was combined with a Kessler repair and tested against the Kessler, Becker, and Savage repairs in fresh human cadaver flexor digitorum profundus tendons. Biomechanical testing was done on a tensile testing machine, and load-displacement curves were generated. The repairs using the external tendon splint demonstrated a range of improvement of 32 to 146% in mean maximal tensile strength and a 20 to 185% improvement of mean ultimate tensile strength compared with all other repairs. The external tendon splint is relatively easy to apply to a tendon. The repair is strengthened and becomes capable of withstanding early active range of motion exercises. In vivo testing will be needed to assess the potential clinical usefulness of such a device.

Finger Injuries↗

PubMedDate not supplied

[Effect of a rasp surface on cement penetration in paired cadaver femurs].

AIM: The purpose of this investigation was to study two different broach surface designs with regard to cement penetration into human cancellous bone. METHODS: In a cadaver study 15 paired human cadaver femora were prepared using broaches of identical geometry but different surface characteristics. All left femora were prepared using chipped toothed broaches, all right femora using diamond shaped broaches. Cancellous bone was irrigated with 1 liter pulsed lavage. The specimens were imbedded in specially designed pots. Bone cement was applied in a retrograde manner and subjected to a standard pressure protocol with a constant force of 3000 N. Radiographs were taken and horizontal sections were obtained at predefined levels using a diamond saw. Microradiographs were taken and analyzed using image analysis to assess cement penetration into cancellous bone. RESULTS: Pressure curves recorded during cement pressurisation were comparable. The microradiographic evaluation revealed no significant morphometric differences in the different groups with regard to cement penetration into cancellous bone. These findings were similar in all sections obtained. CONCLUSIONS: A standardized model was developed allowing comparison of cement penetration into cancellous bone depending on bone preparation. In the presence of pulsed lavage there is no significant influence of broach surface characteristics on cement penetration into cancellous bone of the upper end of the femur.

Bone Cements↗

PubMed2006

[16-Row multidetector CT of the pelvis after iliosacrally inserted osteosynthetic screws: experimental study of dose adjustment on preserved human cadaver specimens].

PURPOSE: The study was performed to assess the necessity of dose adjustment (kV or mAs (eff.)) in 16-slice CT (MDCT) in postoperative controls of iliosacrally inserted osteosynthetic screws (OS) on preserved human cadaver specimens. The minimal tube settings for diagnostic imaging of the pelvic bone were analyzed and the effective doses and important organ doses were calculated. MATERIALS AND METHODS: 16 preserved human cadaver specimens with transiliac osteosynthetic screws were scanned on a 16-slice CT (collimation 16 x 0.75 mm, pitch 0.7) with 10 different tube settings (35, 50, 75, 100, 150 mAs (eff.) and 120 and 140 kV). 32 datasets (blinded for name and scan parameters) with and without OS were independently evaluated by four observers. The 10 series were sorted by subjective image quality (image noise, contours, artifacts), and the series with the lowest but still diagnostic quality was selected. The statistical analysis included multi-rater-kappa-test and Wilcoxon test for paired samples. RESULTS: The multi-reader agreements for sorting the series were fair (kappa = 0.38). The agreements in comparing the lowest diagnostic image qualities were slight to fair (kappa = 0.08-0.23). The paired sample test comparing the lowest diagnostic image quality with and without OS showed no statistical significance (p = 0.29). 87.5 % of the readouts (n = 64 [16 examinations, 4 readers]) with OS and 78.1 % of those without OS could be adequately diagnosed using the three series with the lowest effective doses (0.9-1.4 mSv for men, 1.4-2.0 mSv for women; 120 kV-35 mAs (eff.), 120-50, 140-35). CONCLUSION: MSCT scans of the pelvic bone can be performed with very low effective doses. It is not necessary to adjust tube settings when imaging bones with osteosynthetic screws. If the concept for the control of the pelvic osteosynthetic screw position includes more than 2 conventional films (for example anterioposterior view with additional inlet and outlet views), a low dose CT is preferable to conventional radiography.

Animals↗

PubMed1996

Biportal neuroendoscopic microsurgical approaches to the subarachnoid cisterns. A cadaver study.

A preclinical cadaver study was performed to develop the technique of biportal neuroendoscopic dissection in the subarachnoid space of the basal cisterns and to test the feasibility, utility, and safety of this new technique. In 23 fresh post-mortem adult human cadavers and 2 formalin-fixed adult human head specimen a total of 33 biportal endomicrosurgical dissections into and within the basal cisterns were carried out. Following suction of cerebrospinal fluid from the subarachnoid space 0 degree-, 30 degrees-, and 70 degrees-lens-scopes (Aesculap AG, Tuttlingen, Germany) with outer diameters of 4.2 mm and trochars with outer diameters of 5 to 6.5 mm were introduced into the surgical field. 6 different endoscopic routes to the basal cisterns and a total of 10 different combinations of these approaches for biportal endoneurosurgery could be described, but it was found that not all of them were useful and safe. The transventricular approach to the prepontine cisterns through the foramen of Monro and the floor of the third ventricle, biportally combined with a subfrontal or a subtemporal approach, turned out to be not safe enough as it was accompanied by traumatization of the fornix at the interventricular foramen and of the hypothalamus at the level of the tuber cinereum due to relaxation and caudal shift of the brain following suction of cerebrospinal fluid to clear the basal cisterns for the subfrontal or subtemporal approaches. Useful and safe endomicrosurgical approaches to the basal cisterns were: 1st subfrontal, either epidural or intradural, 2nd subtemporal, either anterior or posterior, and 3rd frontal interhemispheric. Various biportal combinations of these approaches are estimated to be feasible, useful, and safe enough to be performed during microsurgical procedures in the operating room. The biportal endomicrosurgical strategy allows for effective and safe dissections within the subarachnoid spaces of the basal cisterns. The tip of the microinstruments as well as the neighboring anatomical structures can be nicely controlled at angles of about 60 degrees to 180 degrees depending on the viewing angles of the scopes used and depending on the individual shape of the head. A variety of microsurgical instruments has been tested. A number of these will have to be redesigned for this new technique. Regions suitable for biportal neuroendoscopic subarachnoid preparations are the olfactory groove, the prechiasmatic cistern, the region of the optic chiasm, the entire suprasellar area, parts of the parasellar area, the pre- and perimesencephalic cisterns, and the prepontine cistern.

Adult↗

PubMed1982

The mechanism of angioplasty. Dilatation of iliac cadaver arteries with intravascular pressure control.

A model was developed which allows the dilatation of iliac cadaver arteries under normal blood pressure conditions (mean pressure 100 mmHg). Segments of the iliac artery were put under pressure and dilated with balloons under similar conditions as in clinical practice. Purposely oversized balloons were used because most of the arteries did not contain severely stenotic plaques and consequently the commercially available balloons had no effect because of their comparatively small diameter. In spite of the use of oversized balloons, the cadaver arteries could not be significant dilated. Rupture of the intima and media was almost invariably present. Leakage of distending fluid through the adventitia occurred commonly. The "therapeutic range" between minimal dilation and partial or total rupture in postmortem studies is small.

Adolescent↗

PubMed2003

Effect of pelvic tilt on acetabular retroversion: a study of pelves from cadavers.

Pelvic inclination is difficult to control on a standard radiograph of the pelvis and has a direct influence on the appearance of acetabular version. By defining the normal range of the distance between the symphysis and the sacrococcygeal joint on 86 standard anteroposterior radiographs of pelves a technique was developed to evaluate pelvic inclination. A statistically significant correlation between this distance and pelvic inclination was shown in four cadaver pelves. Acetabular retroversion signs (cross-over, posterior wall signs) were evaluated on normal pelves from cadavers (two females, two males) after mounting on a holding device and wire marking of the acetabular rims. Radiographs were taken 3 degrees stepwise through the range of 9 degrees inclination to 12 degrees reclination. At the neutral position, two acetabula appeared with both positive retroversion signs compared with none at 6 degrees reclination. At 9 degrees pelvic inclination all acetabula had both signs. Retroversion signs were significantly more pronounced and found at lower pelvic tilt angles in the pelves from males than from females. Evaluation of pelvic inclination will help to decrease measurement errors in assessment of acetabular orientation and femoral head coverage. This will be valuable in preoperative planning of reorientation procedures.

Acetabulum↗

PubMed2005

Risks to the superior gluteal neurovascular bundle during percutaneous iliosacral screw insertion: an anatomical cadaver study.

BACKGROUND: Iliosacral screws are a popular technique used to treat complicated injuries of the pelvis. It is well recognized that this technique entails some potentially disabling complications, including damage to vessels and lumbosacral nerves. The recommended insertion site for iliosacral screws into the S1 body lies along the posterior ilium between the greater sciatic notch and the iliac crest. The anatomy and course of the superior gluteal nerve and vessels have been described along the outer aspect of the posterior ilium. Injury to the superior gluteal nerve and vessels has been reported during pelvic surgery, including the insertion of iliosacral screws. The purpose of this study is to assess the risks of injury and proximity of percutaneously inserted iliosacral screws to the superior gluteal nerve and vessels using a cadaver model. MATERIALS AND METHODS: Twenty-nine cadaver pelvises for a total of 58 sides (58 screws) were studied. Percutaneous iliosacral screws were placed into the first sacral bodies using multiplanar fluoroscopic guidance. The superior gluteal neurovascular bundle was then studied via a posterior dissection. Injury to the neurovascular bundle was noted if it occurred, and the distance between the screw head and the neurovascular bundle was measured. Distances from the screw head to the crista glutea, greater sciatic notch, and iliac crest were also measured. RESULTS: The branching pattern of the superior gluteal nerve and vessels after they exit the greater sciatic notch demonstrated considerable variation, but was generally consistent with prior descriptions in most cases. Ten of 58 (18%) iliosacral screws caused injury to the superior branch of the superior gluteal nerve and vessels; 8 neurovascular bundles were impaled and 2 others were partly entrapped between the screw head and the ilium. The mean distance from the head of the iliosacral screws to the deep superior branches of the superior gluteal nerve and vessels was 9.1 mm (+/- 6.8 mm). The mean distances from the screw head to the crista glutea, sciatic notch, and iliac crest were 19.5 mm (+/- 4.9 mm), 33.0 mm (+/- 6.4 mm) and 50.3 mm (+/- 4.6 mm). Of the screws that caused superior gluteal nerve and vessels injury, all were within the "desired" area of insertion. CONCLUSIONS: The deep superior branch of the superior gluteal nerve and vessels, which provides major blood and nerve supply to the G. medius and G. minimus, is at significant risk during the percutaneous placement of iliosacral screws even when "well placed" and soft tissue protecting cannulas are used. The clinical effects of these injuries remain poorly understood.

Bone Screws↗

PubMed1981

In situ cadaver kidney perfusion: experimental and clinical studies.

Lactated Ringers and Collins C2 solutions were compared in different volumes for rapid intra-aortic in situ cooling of pig cadaver kidneys. Both solutions in large volumes caused renal damage when compared with ex vivo flushed controls, although C2 was less injurious. When used for in situ cooling of human cadaver kidneys in volumes less than 1,500 ml/kidney, the two solutions were comparable and did not cause injury when compared with controls. In situ cooling permitted longer excision time (cold ischemia) and is recommended for lessening warm ischemia time in selected cases.

Animals↗

PubMed1981

An alternative to cadaver kidney transplants for patients with insulin-dependent diabetes mellitus.

The benefits of successful kidney transplants for patients with end stage renal disease associated with insulin-dependent diabetes mellitus are well known, and the potential advantages of earlier transplantation have been emphasized in other reports. Cadaver transplants, which are not always available for these patients, have not provided a high degree of success in many centers. This has discouraged the use of transplants unless well matched related donors are available. Most patients do not have well matched family members who are able to donate. We have attempted to increase the availability of related transplants for diabetic patients by using a new protocol in which related donors who are poorly matched by mixed lymphocyte culture (MLC) testing (stimulation index (SI) greater than or equal to 7) can often serve as the source of the transplant. This protocol of pretransplant donor-specific transfusions (DSTs) has been applied to 20 diabetic patients. Sixteen transplants have been performed after serial immunological studies following the DSTs detected no specific evidence of recipient sensitization to the respective transfusion donors. Only one of the transplants has been rejected, and this occurred in a patient who intentionally terminated immunosuppressive therapy. Graft survival for the group of 16 patients is 93 and 84% at 1 and 3 years, respectively. The quality of renal function for most of the patients is very good, with a mean serum creatinine of 1.9 and 1.5 ml/dl for those transplants at risk for 12 and 24 months. This new method has given encouraging results for poorly matched related transplants in diabetic patients and makes earlier transplantation possible by providing an alternative to cadaver transplants.

Adult↗