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PubMed1984

Successful DR-incompatible cadaver kidney transplantation. Combined effect of HLA A and B matching and blood transfusion.

The purpose of this retrospective analysis of DR-incompatible cadaver renal transplantation was to evaluate the effect of HLA A and B matching and blood transfusion status on actual one-year graft survival. There were 31 2-DR, 111 1-DR, and 27 0-DR grafts at risk during the study period. First, a comparison was made between preoperative (PRE) and peroperative (PER) transfusions alone. Graft survivals were 70% vs. 92% (2 DR), 67% vs. 52% (1 DR) and 71% vs. 39% (0 DR) for the PRE and PER groups, respectively. Statistical significance was not found between the two values in each DR subgroup, although the difference approached significance in the O DR group (0.1 greater than P greater than 0.05). Matching for greater than or equal to 2 A and B antigens significantly improved graft survival in the 1 DR-matched group when compared with those matched for less than 2 antigens (76% vs. 44%, P less than 0.005). While marked differences between the greater than or equal to 2 and less than 2 A and B matched groups were observed for both the 2 DR (92% vs. 68%, P greater than 0.1) and O DR groups (59% vs. 40%, P greater than 0.3) these differences were not significant. Stratifying the data for transfusion status revealed that the positive influence of HLA A and B matching in the 1 DR group was dependent upon the presence of preoperative blood administration. Graft survival of 87% for the PRE transfused recipients of grafts matched for greater than or equal to 2 A and B antigens was significantly better (P less than 0.001) than the 42% survival observed in similarly transfused recipients of poorer matched organs. Conversely, A and B matching was not significantly beneficial in the 1 DR recipients transfused only at the time of transplant with graft survivals of 57% vs. 43% for those matched for greater than or equal to 2 or less than 2 A and B antigens, respectively (P greater than 0.3). This analysis suggests that a combined effect of both HLA A and B matching and preoperative blood transfusions may allow for highly successful first cadaver renal transplantation in the face of DR incompatibility.

Adolescent↗
PubMed1986

The importance of the Lewis system in cadaver renal transplantation.

Previous reports have suggested that Lewis (Le) antigens may exert a significant effect on cadaver renal allograft (CRA) survival, especially in black recipients in whom there is a higher frequency of Le-negative phenotypes. We review our experience with this problem in 70 donor-recipient pairs of CRA who underwent prospective Le typing and received conventional immunosuppression between 1980 and 1983. Recipient typing alone yielded the following graft survival (GS) and patient survival (PS) at 2 years by life table analysis: (a+,b;-) (n = 12) 51% GS, 93% PS; (a-, b+) (n = 44) 57% GS, 88% PS; and (a-,b-) (n = 14) 51% GS, 93% PS(P-ns for GS, PS). Recipient racial characteristics did not effect ultimate graft survival, as whites and blacks had similar two-year GS in all phenotypic groups. When Le matching was considered, no significant differences in one-year graft survivals could be ascertained between Le-matched and Le-mismatched donor-recipient pairs, and this effect persisted despite stratification for race and HLA-A,B and DR histoincompatibilities. In light of these results, we do not recommend using Lewis compatibility as a criterion for donor selection in cadaver renal allografting, as this substantially increases the difficulty in finding suitable matches, especially in the (a-,b-) recipient group.

Black People↗
PubMed1986

Detrimental effect of cyclosporine on initial function of cadaver renal allografts following extended preservation. Results of a randomized prospective study.

We report herein the results of a randomized prospective trial comparing maintenance cyclosporine (CsA)-prednisone immunosuppression to a regimen of azathioprine-prednisone-antilymphocyte globulin (ALG) in cadaver renal transplant recipients. Fifty-six patients were entered into this study with 31 assigned to the ALG group and 25 to the CsA group. These two groups were well matched for most major determinants of graft outcome and the mean renal preservation time was 37 hr in each group. The incidence of acute tubular necrosis (ATN) was high in both groups (58% ALG, 72% CsA, NS). There were five cases of primary nonfunction in the CsA group and only one in the ALG group (P = .05). Of the kidneys that functioned, the mean serum creatinine nadir (1.5 vs. 2.2 mg/dl, P = .06) and the mean number of days to reach the serum creatinine nadir (24.2 vs. 43.3 days, P = .03) were both less in the ALG group. The actuarial one-year graft survival rate in the ALG and CsA groups is 78% and 48%, respectively (P less than .05). This difference is mainly due to the large number of primary nonfunctioning grafts in the latter group, which we attribute to the effect of CsA's nephrotoxicity superimposed on renal ischemia incurred prior to transplantation. These data emphasize that, in order to realize the full benefit of CsA in cadaver transplantation, renewed emphasis must be placed on minimizing ischemic renal damage.

Adolescent↗
PubMed1989

Use of cryopreserved donor bone marrow in cadaver kidney allograft recipients.

Donor-specific unresponsiveness to organ allografts remains an elusive goal in clinical transplantation, as most successful experimental protocols for the production of antigen-specific immunosuppression require lengthy recipient pretreatment. The use of an induction course of antilymphocyte serum (ALS) beginning at the time of transplantation, followed by the transfusion to the recipient of donor-specific bone marrow, has been shown in animals to induce prolonged allograft survival and is applicable for use in cadaver donor clinical transplantation. Our preliminary data in humans suggest that the transfusion of cryopreserved cadaver donor bone marrow following a short course of ALS is safe and does not induce graft-versus-host disease or allograft rejection. Twenty patients have been included in the protocol and 19 have been discharged from the hospital with functioning kidney transplants. One graft failed at 3 months. Eight patients have been withdrawn entirely from prednisone immunosuppression 3-6 months following transplantation. The contralateral kidneys from the marrow donors were transplanted into an additional 20 patients who received sequential immunosuppressive therapy without marrow transfusion. Three of these grafts have failed within 3 months due to acute rejection. Donor marrow transfusion may give rise to improved allograft and patient survival in clinical transplantation while at the same time allow for reduced requirements for nonspecific immunosuppressive agents with their undesirable side effects.

Bone Marrow Transplantation↗
PubMed1996

Delayed graft function in the absence of rejection has no long-term impact. A study of cadaver kidney recipients with good graft function at 1 year after transplantation.

We previously reported that delayed graft function (DGF) in the absence of biopsy-proven acute rejection (Rej) had no effect on outcome of primary cadaver kidney transplantation (TX). By contrast, DGF in combination with Rej strongly predicted poor long-term graft survival. We asked whether this poor long-term outcome was due to early graft loss associated with DGF, or to an ongoing process leading to late graft loss. To answer this question, we studied a subset of 298 cadaver kidney transplant recipients who had not suffered early graft loss and had a serum creatinine level < or = 2.0 mg/dl at 1 year after TX. The incidence of DGF (defined by dialysis during the first week after TX) in this subset was 19%. DGF was associated with cold ischemia time >24 hr (P = 0.0003) and Rej (P = 0.06). For grafts with versus without DGF, the incidence of late acute Rej (>1 year after TX) was similar. Actuarial graft survival was similar for Rej-free recipients with versus without DGF (P = 0.9) and was worse for those with Rej and no DGF (P < 0.02). Importantly, however, in our recipients who all had a serum creatinine level < or = 2.0 mg/dl at 1 year after TX, the worst long-term outcome was noted in the subgroup with both DGF and Rej (P < 0.0001). By multivariate analysis, DGF was also only a risk factor in combination with Rej (P = 0.002, relative risk = 3.7), while a 0-antigen HLA mismatch had no impact. Patient survival decreased for recipients with both DGF and Rej by univariate (P = 0.009) and multivariate (P = 0.02, relative risk = 2.9) analyses. We conclude that DGF without Rej has no impact on long-term survival. However, our data for recipients with both DGF and Rej suggest that a chronic ongoing process leads to late graft failure. Further research is necessary to identify the exact pathophysiology of this process, which appears to be, at least in part, HLA antigen independent.

Acute Disease↗
PubMed2005

Standard multiplanar fluoroscopy versus a fluoroscopically based navigation system for the percutaneous insertion of iliosacral screws: a cadaver model.

OBJECTIVES: To compare the safety and efficiency of standard multiplanar fluoroscopy (StdFluoro) and virtual fluoroscopy (VirtualFluoro) for use in the percutaneous insertion of iliosacral screws. DESIGN: : Human cadaver study comparing 2 imaging modalities during iliosacral screw insertion; imaging randomized from side to side. SETTING: Bioskills laboratory in a medical school. PARTICIPANTS: Twenty-nine embalmed whole human cadavers without prior hip or pelvic surgery. INTERVENTION: Iliosacral screws were inserted into the S1 bodies using a percutaneous insertion technique. Screws were inserted on one side using StdFluoro, and on the other side, screws were placed using VirtualFluoro. MAIN OUTCOME MEASUREMENTS: Time necessary for imaging preparation, screw insertion, and actual fluoroscopy were recorded. Accuracy and safety of screw placement was assessed using computed tomography and an anatomic dissection of the pelvis. RESULTS: : Fifty-six of 58 iliosacral screws were placed within the desired bony corridor of the posterior pelvis. One screw placed using each method was inserted erroneously, but both were relatively minor deviations. There were no obvious injuries to major vessels or nerve roots. The total surgical time required for preparation of imaging and screw insertion averaged 7.3 minutes using StdFluoro and 6.7 minutes using VirtualFluoro (P = 0.4). Although the time necessary for screw insertion using VirtualFluoro averaged only 3.5 minutes, compared to 7.0 minutes for StdFluoro (P < 0.05), this time savings was offset by that required for application and calibration of tracking devices when using VirtualFluoro. The average fluoroscopy time using StdFluoro method was 26 seconds, whereas that for the VirtualFluoro was only 6 seconds (P < 0.01). CONCLUSIONS: Most of the percutaneous iliosacral screws were safely inserted using StdFluoro and VirtualFluoro, and total surgical times were similar using both methods. As VirtualFluoro continues to evolve, improved efficiency in operative times may be expected. Currently, the most beneficial aspect of using VirtualFluoro during the insertion of percutaneous iliosacral screws appears to be significantly decreased use of fluoroscopy when compared to StdFluoro.

Aged↗
PubMed2004

Biomechanical assessment of conventional unit rod fixation versus a unit rod pedicle screw construct: a human cadaver study.

STUDY DESIGN: Fresh frozen human cadaver specimens were used to perform a biomechanical assessment focusing on spinal-pelvic fixation. Unit rod fixation alone was compared with that of unit rod fixation supplemented with L5 pedicle screws. OBJECTIVES: To investigate the biomechanical effects of adding L5 pedicle screw fixation to a unit rod construct. SUMMARY OF BACKGROUND DATA: The treatment of neuromuscular scoliosis associated with pelvic obliquity continues to evolve. Spinal fusion using fixation extending from the thoracic spine to the pelvis supplemented with segmental instrumentation has become the standard of care. The instrumentation of choice used at this institution has been a unit rod construct. Traditional Luque-Galveston technique with sublaminar wiring from T2 to L5 has been used. A noted complication has been a loss of distal fixation, the emphasis for this study. We have subsequently modified this technique, replacing wires at L5 with pedicle screws. This was done to improve the strength of the distal fixation, with the goal of decreasing the rate of instrumentation failure before fusion. METHODS: Twelve fresh-frozen human cadavers, between the ages of 45 and 60 years, were instrumented from T4 to the pelvis with a Unit Rod (Sofamor Danek). The specimens were randomized into two groups. Segmental sublaminar wiring was performed from T4 to L5 in one group of six spines. The remaining six spines underwent sublaminar wiring from T4 to L4, with pedicle screws used for L5 fixation. The spines were then potted from T4 to T7 in preparation for biomechanical testing. The spines were tested in a randomized fashion for subfailure stiffness in anteroposterior, oblique, and lateral planes with an Instron 1321 servo-hydraulic load frame (Instron Corp., Canton, MA). Each spine was then loaded to failure in forward flexion. RESULTS: Our results demonstrate a statistically significant increase in lateral stiffness (P = 0.0006) and oblique stiffness (P = 0.003) associated with the use of L5 pedicle screws. Statistical significance was also achieved with load to failure testing (P = 0.0007). The mean load to failure was 1377 Newtons for the pedicle screw construct and 467 Newtons for the wire construct. CONCLUSIONS: We conclude that the addition of L5 pedicle screws increases the stiffness and strength of the unit rod construct. Clinically, this should help to avoid complications associated with loss of fixation in this area.

Biomechanical Phenomena↗
PubMed2005

Pedicle screw placement in the thoracic spine: a comparison of image-guided and manual techniques in cadavers.

STUDY DESIGN: A cadaveric study comparing image guidance technology to fluoroscopic guidance as a means of pedicle screw placement in the thoracic spine, using a unique starting point for screw placement. OBJECTIVE: To assess accuracy of thoracic pedicle screw placement using image guidance versus fluoroscopic guidance for screw insertion. SUMMARY OF BACKGROUND DATA: While use of pedicle screws in the thoracic spine has been increasing, its adoption has been slower than for the lumbar spine, reflecting concern regarding possible vascular or spinal cord injury due to screw malplacement. Given these risks, efforts to improve the accuracy of thoracic pedicle screw placement remain appropriate. Stereotactic guidance has been applied in other aspects of spinal surgery to improve the accuracy of instrumentation placement. METHODS: Pedicle screws were placed in the thoracic spines of eight cadavers, using either a stereotactic guidance or a manual, fluoroscopically guided technique. A slightly more superior and lateral starting point from prior descriptions was used. Each cadaver was instrumented with pedicle screws in the upper thoracic (T1-T2), middle thoracic (T4-T7), and lower thoracic (T9-T10) regions. In the upper and middle thoracic regions, screws with a 4.0-mm shank diameter were used while in the lower thoracic region a shank diameter of 4.5 mm was used. Postinstrumentation CT scans, followed by anatomic dissections, were used to evaluate screw exit rates and orientation relative to the pedicle axis. Exit rates for the two techniques and the effect of vertebral level on exit rate were compared using a chi analysis. The effect of pedicle diameter was tested using a Pearson correlation coefficient. RESULTS: No significant differences in the overall exit rates or orientation were found between the two techniques. There were significant differences in exit rates between the middle (47%), compared with the upper (9%) and lower (16%) thoracic regions, respectively (P < 0.001). A significant correlation between pedicle diameter and exit rate was also found (P < 0.0001). CONCLUSION: Our study showed no significant differences in the overall exit rates between the two techniques. Image guidance may increase confidence of surgeons with limited experience in thoracic pedicle screw placement. Successful placement of screws within the pedicle varies with the anatomic diameter of the pedicle itself. Concerns regarding accuracy of screw placement should be greatest in the middle thoracic vertebrae (T4-T7), where pedicle diameters are smallest and proximity of the great vessels is nearest.

Bone Screws↗
PubMedDate not supplied

Correlation of anatomy and ultrasonographic images in the infant hip: an experimental cadaver study.

An experimental study was performed to correlate images of the infant hip obtained by ultrasonography with documented anatomic relationships. Two term stillborn neonatal cadavers were studied by imaging approaches used clinically. Specific anatomic structures were marked with echo-dense metal. The dissected cadaver hip joint was imaged in located and dislocated positions while immersed in a water bath. The results of the studies confirm the accuracy of ultrasonography in visualizing the cartilaginous structures of the infant hip joint. The experimentally obtained images correlate well with images obtained clinically.

Cartilage, Articular↗
PubMed1981

The influence of HLA-DR match on the outcome of cadaver renal transplantation in Stockholm during 1977-1980.

The influence of HLA-DR match grade on graft and on patient survival was analyzed in 124 recipients of cadaver kidneys who were treated in Stockholm between January 1977 and September 1980. The material consisted of 72 males and 52 females, with a mean age of 49 years. There were 34 re-transplantations. Eighteen of the recipients had diabetes. Sera against the HLA-DR antigens 1-4, 7 and DRw8 were available throughout. During recent years, DR5 sera were also used. The case material was analyzed as to the number of DR antigens shared or to the number of DR incompatibilities between the donor and the recipient. A significant improvement in graft survival rate was found for transplants sharing one HLA-DR antigen as compared with those sharing none. As far as incompatibilities are concerned, a significant difference was found between transplants with no incompatibilities and those with two. The HLA-A, B incompatibilities were evenly distributed throughout the various groups and thus should not have introduced a bias in the interpretation of the influence of HLA-DR match. We conclude that HLA-DR matching has a very beneficial effect on the graft survival rate and we shall in future try to obtain the best possible match when selecting recipients for cadaver kidney transplantation.

Adult↗
PubMed2003

Experimental third ventriculostomy performed using endovascular surgical techniques and their adaptation to percutaneous intradural neuronavigation: proof of concept cadaver study.

OBJECTIVE: Endoscopic third ventriculostomy has developed into a therapeutic alternative to shunting for the management of carefully selected patients with primarily noncommunicating hydrocephalus. This procedure, however, requires a general anesthetic and necessitates violation of the brain parenchyma and manipulation near vital neural structures to access the floor of the third ventricle. Using two cadavers and off-the-shelf angiographic catheters, we sought to determine whether it was possible to navigate a catheter, angioplasty balloon, and stent percutaneously through the subarachnoid space from the thecal sac into the third ventricle so as to perform a third ventriculostomy from below. METHODS: Using biplane angiography and off-the-shelf angiographic catheters along with angioplasty balloons and stents, we were able to pass a stent coaxially from the thecal sac to and across the floor of the third ventricle so as to achieve a third ventriculostomy from below. RESULTS: Coaxial catheter techniques allowed for the percutaneous insertion of a stent across the floor of the third ventricle. Ventriculostomy was confirmed by injecting contrast medium into the lateral ventricle and seeing it pass through the stent and into the chiasmatic cistern. CONCLUSION: We describe the performance of third ventriculostomies in two cadavers by use of the new concept of percutaneous intradural neuronavigation. This procedure may obviate the need for general anesthetic and minimize the potential for brain and vascular injury, especially if ultimately combined with magnetic resonance fluoroscopy.

Adult↗
PubMed2001

The surgical technique and the age of the horse both influence the outcome of mosaicplasty in a cadaver equine stifle model.

Six pieces of grafts, 6.5 mm in diameter, 20 mm in length, were taken from each of 170 cadaver hindlimbs, using the cranial surface of the medial femoral trochlea for harvesting. The age of the horses varied between 4 months and 23 years. 30 limbs under the age of 12 years were selected for transplantation. Three of six grafts were transplanted into the medial femoral condyle using different combinations of tunnel depth and dilation. With ageing, a significant decline in transplantability was detected. In general, mosaicplasty cannot be recommended in horses above 11 years. Based on a previous clinical case (Bodó et al., 2000), a good surface alignment was indeed achieved with a combination of graft length drilling and dilation in most cases. However, the occasional entrapment of cartilage debris under the graft prevented perfect alignment in the present cadaver study in 27% of the grafts transplanted in this manner. Since the protrusion of grafts never exceeded 1.5 mm, we conclude that drilling 3-5 mm deeper than graft length with graft length deep dilation can avoid disadvantageous protrusion of the transplanted hyaline cartilage caps, achieving bone decompression at the same time.

Age Factors↗
PubMed1994

Detection of pooled secretions above endotracheal-tube cuffs: value of plain radiographs in sheep cadavers and patients.

OBJECTIVE: Mechanical ventilation is thought to increase the risk of nosocomial pneumonia by permitting leakage of bacteria-laden gastro-oropharyngeal secretions into the upper airways. The goal of this study was (a) to validate radiographic signs of pooled secretions above endotracheal-tube cuffs (supracuff liquid) in an animal model and (b) to determine whether suctionable pooled supracuff liquid can be identified on bedside radiographs of intubated patients. MATERIALS AND METHODS: Diagnostic criteria for supracuff liquid were initially validated by three radiologists interpreting 162 randomized radiographs made in an intubated sheep cadaver. The primary criteria included (a) replacement of the normal supracuff lucency with liquid opacity and (b) the formation of a sharp interface between the lucency of the upper edge of the cuff below and the liquid above. Graded infusions of 0, 3, 8, 13, and 23 ml of saline were made in triplicate into the space above the cuff, and radiographs were evaluated for the presence or absence of saline. The validated diagnostic criteria were used by two radiologists to estimate the frequency with which pooled liquid was seen on portable chest radiographs of 47 patients undergoing elective short-term postanesthetic mechanical ventilation. RESULTS: In the sheep-cadaver model, the diagnostic criteria for supracuff liquid allowed successful differentiation between no liquid, a small amount of liquid (3-8 ml), and a large amount of liquid (13-23 ml; c2, p < .0001). In a clinical study, radiographic signs of supracuff liquid were identified in 57% of 47 patients. In a small subset of patients (n = 18), the estimated liquid volume (mean +/- SEM) was calculated to be 7.8 +/- 1.1 ml (range = 2.1-18.4 ml). CONCLUSIONS: Radiography is a sensitive means of identifying small volumes of supracuff liquid above the inflated cuffs of endotracheal tubes. Potentially contaminating liquid pooled above the cuff of an endotracheal tube can be identified in about half of patients undergoing short-term mechanical ventilation. Our results suggest the suction of the supracuff space may be a reasonable prophylactic maneuver against nosocomial pneumonia. A much larger study is suggested to investigate the actual relation between pooled supracuff liquid and the development of nosocomial pneumonia.

Adult↗
PubMed1995

Distension of extrapleural spaces with contrast medium or air: value in creating safe percutaneous access to the mediastinum in cadavers.

OBJECTIVE: We artificially widened the extrapleural space with contrast medium or air in 33 cadavers to create a safe extrapleural route to the anterior mediastinum and the posterior mediastinum for large-bore needle biopsies. MATERIAL AND METHODS: Under CT guidance, 120 ml of diluted contrast medium (10%) or 300 ml of air was injected percutaneously into the right paravertebral (n = 23) and left retroaortic (n = 5) or ventral parasternal (n = 5) extrapleural spaces. RESULTS: In six of 18 cases, the paravertebral space was found to be wide enough to advance a 14-gauge cannula to the extrapleural paraesophageal space. After injection of 120 ml of diluted contrast medium, the width of the right paravertebral space at the level of the posterior rim of the vertebral body was dilated from a mean of 0.62 cm to 1.06 cm, and the width of the anterior rim was dilated from a mean of 0.91 cm to 1.97 cm. In 17 of 18 cases, the paravertebral space was wide enough to accommodate a 14-gauge cannula. A large osteophyte blocked the access route in one case. Artificial widening regresses within 7 min by an average of 33% at the level of the posterior rim of the vertebral body and by an average of 18% at the level of the anterior rim. Dilatation was significantly more effective with diluted contrast medium than with air. When 120 ml of diluted contrast medium was injected into the left retroaortic extrapleural space, the distance between the aorta and the vertebral column was widened from a mean of 0.40 cm to 1.50 cm. Using a ventral approach for injecting 120 ml of solution, we widened the parasternal access route from a mean of 0.42 cm to 1.90 cm. CONCLUSION: In this cadaver study, artificial dilatation of the mediastinum with diluted contrast medium allowed extrapleural access from right paravertebral, left retroaortic, and parasternal directions for large-bore needle biopsies.

Biopsy, Needle↗
PubMed1995

MR arthrography of the hip: improved imaging of the acetabular labrum with histologic correlation in cadavers.

OBJECTIVE: The objective of this study was to correlate findings on conventional MR imaging and MR arthrography of the hip with pathologic findings in cadavers with abnormal labra to determine (1) the efficacy of MR imaging in assessing labral degeneration, (2) whether delineation of the labrum from the joint capsule is possible, and (3) if the conspicuity of surface abnormalities of the labrum is improved by administering intraarticular contrast material. MATERIALS AND METHODS: Twelve cadaveric hip joints were obtained from elderly cadavers. Each hip was examined using fat-suppressed three-dimensional spoiled GRASS (gradient-recalled acquisition in the steady state) (SPGR) imaging and T1-weighted spin-echo imaging before and after intraarticular injection of contrast material. Thirty-six labral sections (three from each hip joint) were evaluated histologically to determine the labral-capsular relationship, the presence of degeneration, and the configuration of the labral base. These findings were correlated with the results of a blinded MR evaluation of these sections. RESULTS: Delineation of the labrum from the adjacent joint capsule was possible on SPGR and T1-weighted MR arthrographic images (34 of 36 and 33 of 36 specimens, respectively), but was not consistently possible on standard SPGR and T1-weighted MR images (7 of 36 and 4 of 36 specimens, respectively). The sensitivities and specificities of the various MR sequences in evaluating labral degeneration varied from 50% to 67%, and from 25% to 94%. Increased signal at the base was common in both the normal (n = 12) and the abnormal (n = 24) labrum. CONCLUSION: Conspicuity of the acetabular labral complex is enhanced with the intraarticular administration of contrast material. Although MR arthrography did not improve our specificity for diagnosing labral degeneration, the detection of surface abnormalities, particularly those near the base, was significantly improved.

Acetabulum↗
PubMed2005

Morphological observation of the horseshoe kidney with special reference to the vascular system in 2 Japanese cadavers.

Two cases of the horseshoe kidney in Japanese cadaver were reported in this paper. The kidneys and their associated vessels in the retroperitoneal cavity were carefully examined, and the histological examination of the isthmus was performed. In Case 1, four arteries arose from the abdominal aorta. One right and two left renal arteries were distributed to the apical, upper, middle and posterior regions of the kidney, respectively, and the artery of isthmus entered the lower segments and the isthmus. In Case 2, six arteries arose from the abdominal aorta. Among three arteries arose from the inferior end of the aorta and entered the lower segments and the isthmus. Histological study revealed that the isthmuses consisted of collecting tubes, glomeruli and urinary tubules and fibrous connective tissue. The incidence of the horseshoe kidney during the dissecting practice at Tokyo Medical University in a period of 24 years from 1980 to 2003 was estimated to be 0.16% (2 out of the 1,219 cadavers). The anatomical and embryological significance of this anomaly and its associated vascular system were discussed. And the histology of the parenchymal structure of the isthmus in the horseshoe kidney containing either fibrous connective tissue or renal parenchyma was also analyzed in this report.

Aged↗
PubMed1987

External fixation of proximal humerus fracture. Clinical and cadaver study of pinning technique.

The risk of injuring important anatomic structures or interfering with motion of the glenohumeral joint by transcutaneous pinning of the proximal end of the humerus was investigated in 12 cadaver shoulders and in 23 patients with displaced fractures of the proximal humerus. In the cadavers, pinning of the proximal humeral shaft from laterally more than 20 mm below the surgical neck did not injure the neurovascular structures in any case. Pin insertions into the humeral head medial to the intertubercular groove endangered the cephalic vein and interfered with shoulder function by transfixing the subacromial bursa and by restricting internal rotation. Lateral pinning did not carry such risk. In the patients closed reduction and external fixation confirmed the low risk of neurovascular injuries. Lateral pinning of the humeral head resulted in an unrestricted passive mobility of the glenohumeral joint of the anesthetized patient, whereas anterior pinning carried the risk of mechanical restriction of the internal rotation.

Adult↗
PubMedDate not supplied

Permeation kinetics of ketotifen fumarate alone and in combination with hydrophobic permeation enhancers through human cadaver epidermis.

Permeation kinetics for ketotifen fumarate from transdermal system through hairless mice skin and hog skin have been reported. However, permeation of ketotifen fumarate through human skin is not available till date. In view of the above, permeation profile and related kinetic parameters of ketotifen fumarate alone and in presence of three compatible enhancers namely Myristic acid isopropyl ester, Palmitic acid propyl ester and Lauric acid propyl ester through normal and delipidized human cadaver have been reported in the present study. The observed permeability flux, permeation coefficient and epidermal partition coefficient through 50% dried human cadaver epidermis were found to increase in presence of the three enhancers, amongst which the effect was found to be maximum with Myristic acid isopropyl ester. The more pronounced enhancing effect of Myristic acid isopropyl ester regarding permeability flux, permeation coefficient, epidermal partition coefficient and diffusion coefficient was attributed with solubility parameter being nearer to the skin lipid solubility parameter and probably due to its passage across the skin barrier through the lipid pathway.

Administration, Topical↗