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PubMed1999

Anatomic and surgical approach to the ethmoidal nerve and parasympathetic innervation of the nasal and cerebral circulation in sheep.

OBJECTIVE: To describe an anatomic and surgical approach to the efferent parasympathetic branches of the pterygopalatine ganglia in sheep, with particular reference to the ethmoidal nerve and innervation of nasal and cerebral blood vessels. ANIMALS: 12 adult sheep used for monolateral (n = 7) or bilateral (n = 5) ethmoidal neurectomy; 2 sheep used for angiography (1 live sheep for digital subtraction angiography, 1 embalmed cadaver for injection studies); and 5 embalmed cadavers, 4 frozen specimens, and 2 dry skulls used for dissection, x-rays, and computed tomographic (CT) or magnetic resonance (MR) scans. PROCEDURE: Transverse (coronal) MR scans, transverse, sagittal, and dorsal CT scans, radiography, angiography, photographic images, and dissections of embalmed material were used to study the topographic anatomy of the temporal and pterygopalatine fossae of the head. RESULTS: Images were stored, then compared with photographs of frozen sections from the same or a similar specimen to plan a surgical approach to the ethmoidal nerve. Mono- and bilateral experimental ethmoidal neurectomies were performed, allowing characterization of a safe and reliable method. The series of pterygopalatine ganglia typical of this species was localized, dissected, and analyzed for topographic relations. CONCLUSIONS: From the results, a new approach to the efferent branches of the pterygopalatine ganglia (ethmoidal nerve) for experimental parasympathectomy of the cerebral and nasal circle is proposed. This experimental approach could be used for studies involving thermoregulation of the face, and in experimental control of blood flow in the nasal cavity and rostral part of the brain.

Angiography, Digital Subtraction↗
PubMed1991

Universal precautions and mortuary practitioners: influence on practices and risk of occupationally acquired infection.

Embalming, the most common funeral practice in the United States, may expose the embalmer to infectious diseases and blood. We surveyed the 860 members of the National Selected Morticians in 1988 to estimate the incidence of self-reported occupational contact with blood and infectious disease, assess morticians' knowledge of acquired immunodeficiency syndrome (AIDS), determine their adherence to universal precautions, and identify predictors of practices designed to reduce risk of occupational exposure to infections. Of 539 (63%) respondents, 212 (39%) reported needle-stick injuries in the past 12 months, and 15 (3%) reported percutaneous exposures to the blood of a decedent with AIDS. Those rating the risk of occupationally acquired human immunodeficiency virus infection as very high or high (194/539 [36%]) were more likely to decline funerals of decedents with antemortem diagnosis of AIDS (59/194 [30%]) and/or to charge more for such funerals (133/194 [69%]) than those who rated the risk as low to moderate (31/345 [9%], 174/135 [51%]).

Acquired Immunodeficiency Syndrome↗
PubMed1988

Contact dermatitis in funeral service workers.

84 funeral service workers and 38 control workers were evaluated for the presence of skin disease by history, clinical examination and patch tests with formaldehyde and glutaraldehyde. No relationship between either personal or family history of cutaneous or respiratory manifestations of atopy and clinical parameters of cutaneous disease or patch test results was found. Cutaneous disease was reported in apprentices, active embalmers and inactive embalmers in decreasing order of frequency. Positive patch test reactions to formaldehyde and glutaraldehyde were found in 4% and 7% of the exposed workers, but in none of the controls. Although exposure to glutaraldehyde was less frequent, the prevalence of positive patch test reactions did not differ. This may suggest that glutaraldehyde poses a greater practical risk of cutaneous sensitization in this trade than formaldehyde.

Adult↗
PubMed1990

[Preservation of human cadavers throughout history--a contribution to development and methodology].

From ancient times to nowadays man tried out of different intentions to keep the bodies of dead persons in the best possible state of preservation. The embalming procedures primary aim at avoiding or at least stopping rottness and autolysis. They have to change depending on the technical possibilities and further destiny of the embalmed bodies. Beside a short historical review we present the method used at our institute.

Autopsy↗
PubMed2001

A review and meta-analysis of formaldehyde exposure and pancreatic cancer.

BACKGROUND: Most reviews on the carcinogenicity of formaldehyde have focused on cancers of the respiratory tract. Two recent studies have suggested that exposure to formaldehyde may increase the risk for pancreatic cancer. METHODS: We examine 14 epidemiology studies of workers exposed to formaldehyde where pancreatic cancer rates were reported and use meta-analytic techniques to summarize the findings. We also rank formaldehyde exposures for the industries in these studies. RESULTS: We found a small increase of pancreatic cancer risk in the studies overall (meta Relative Risk [mRR] 1.1, 95%CI 1.0-1.3); however, this increased risk was limited to embalmers (mRR 1.3, 95%CI 1.0-1.6) and pathologists and anatomists (mRR 1.3, 95%CI 1.0-1.7). There was no increased risk among industrial workers (mRR 0.9, 95%CI 0.8-1.1) who on average had the highest formaldehyde exposures. CONCLUSIONS: A small increased risk of pancreatic cancer from formaldehyde exposure cannot be ruled out from the studies examined. However, the null findings among industrial workers and the lack of biological plausibility would argue against formaldehyde as a cause. The increased risk of pancreatic cancer among embalmers, pathologists, and anatomists may be due to a diagnostic bias or to occupational exposures other than formaldehyde in these professions.

Formaldehyde↗
PubMed1995

Brief communication: skeletal evidence of operations on cadavers from Sens (Yonne, France) at the end of the XVth century.

Human remains giving direct evidence concerning the history of dissection practices are rare. Thirteen cranial fragments which bear evidence of having been purposely cut and sawn were discovered in a crypt during excavations undertaken in Sens (Yonne, France). Ceramics date these remains to the period from the end of the XIVth to the end of the XVIth centuries. Nine individuals are represented: one adolescent and eight adults of both sexes. The position of the cutmarks, which were produced by a long, sharp cutting tool, show that the scalp was completely removed from the skull. The sawing, which was done with a large-toothed saw, was both clockwise and counterclockwise in direction. The sawn surfaces reveal a deliberate attempt not to damage the brain. This procedure is compared to that of modern autopsies. The remains from Sens are also compared with several other sawn cranial fragments recently discovered in France and England. Three hypotheses are discussed: embalmment, autopsy, and anatomical studies. Analysis of these remains and historical documentation suggest embalmment and/or autopsy as the probable purpose of the opening of the skull.

Adult↗
PubMed2001

Gross anatomy in the surgical curriculum in Switzerland: improved cadaver preservation, anatomical models, and course development.

The invention of new techniques for surgery and interventional radiology demand improved training for ongoing specialists. The Anatomical Institutes in Switzerland support these requirements by establishing hands-on practical training courses by using new procedures for cadaver embalming and model construction. Improvements allow courses to provide students with more realistic simulations of both established and experimental surgical methods. Through these changes, the value of in-depth gross anatomy is enhanced as a topic of fundamental importance for the postgraduate medical and surgical curriculum. The web site http://www.unifr.ch/sgahe/snga.html contains information on courses using the Thiel embalming solution. Details about training courses in Switzerland using anatomical models are available at http://www.heartlab.org, http://www.vascular-international.org, and http://www.elastrat.com.

Anatomy↗
PubMed2003

Surgically relevant structure on the ascending aorta.

We have examined the transverse vascularized ridge observed on the anterior surface of the intra-pericardial aorta during cardiac surgery. The ridge was a consistent feature of 20 consecutive cardiac patients and 11 cadavers no more than 2 days post-mortem. The aortic ridge was absent, however, in four of five embalmed cadavers additionally examined, probably due to the embalming process. Histological examination showed the ridge to be well vascularized, well innervated and composed of adipose tissue. This structure has surgical relevance as a possible source of post-operative hemorrhage, sometimes necessitating re-sternotomy.

Adipose Tissue↗
PubMed1996

Clinical and biomechanical aspects of external fixation of the pelvis.

OBJECTIVE: The aim was to evaluate the mechanical stability of several traditional and modern external fixators in unstable pelvic ring disruption. DESIGN: In a laboratory study external and internal fixation techniques were tested in seven fresh and five embalmed human pelves with a disruption of the pubic symphysis and one sacroiliac joint (type C1.2 injury according to the Tile-AO classification). BACKGROUND: Stability provided by external fixation depends upon many factors, with the residual pelvic stability being the most important. METHODS: Simulating a single-leg stance, the load was applied quasi-statically to the acetabulum of the unstable hemipelvis. Device failure was defined as displacement >10 mm either at the symphysis pubis or the sacroiliac joint. RESULTS: The frame with the highest failure load (fresh versus embalmed specimens) was the Egbers configuration with the AO fixator (analysis of variance; P < 0.05). Failure was noted at 114.9 N versus 129.5 N. Augmentation of the Mono-Tube by additional internal posterior osteosynthesis gave the following results: sacral bars 325.4 N versus 217.8 N, plate fixation 294.3 N versus 215.8 N, lag screws 338.4 N versus 215.8 N. Failure loads of hybrid fixation of the Orthofix were as follows: sacral bars 257.9 N versus 213.9 N, plate fixation 333.5 N versus 245.3 N, lag screws 397.3 N versus 280.6 N. The differences between the two fixators were not statistically significant. CONCLUSIONS: No single external frame provided sufficient stability. The addition of a posterior internal fixation significantly increased failure loads and controlled the weight-bearing pelvic elements.

Journal Article↗
PubMed2003

The iliolumbar ligament: its influence on stability of the sacroiliac joint.

STUDY DESIGN: In human specimens the influence of the iliolumbar ligament on sacroiliac joint stability was tested during incremental moments applied to the sacroiliac joints. OBJECTIVES: To assess whether the iliolumbar ligament is able to restrict sacroiliac joint mobility in embalmed cadavers. BACKGROUND: Firstly, the sacroiliac joint can play an important role in non-specific low back pain; hence, its mobility and stability are of special interest. Secondly, the iliolumbar ligament is considered to be an important source of chronic low back pain. Data on a functional relation between the iliolumbar ligament and sacroiliac joint mobility are lacking. METHODS: In 12 human specimens an incremental moment was applied to the sacroiliac joint to induce rotation in the sagittal plane. After the assessment of the relationship between rotation angle and moment in the intact situation, specific parts of the iliolumbar ligaments were transected. After each partial transection the measurements were repeated. RESULTS: Sacroiliac joint mobility in the sagittal plane was significantly increased after a total cut of both iliolumbar ligaments. This increase was in particular due to the transection of a specific part of the iliolumbar ligament, the ventral band. CONCLUSIONS: The main conclusions are: (a) the iliolumbar ligaments restrict sacroiliac joint sagittal mobility; (b) the ventral band of the iliolumbar ligament contributes most to this restriction. RELEVANCE: In embalmed human cadavers, the mobility of the sacroiliac joint increases after sequential cutting of specific parts of the iliolumbar ligaments. It can be expected that severance of this ligament during surgery will lead to increase of mobility and hence loss of stability of the sacroiliac joint. As a consequence adjacent structures will be affected. This may well be a cause of pain in patients with failed back surgery.

Aged↗
PubMed1975

Formaldehyde and paraformaldehyde study in funeral homes.

Formaldehyde is a toxic gas and classed as an upper respiratory irritant. The gas possesses distinctive physiological properties causing symptoms familiar to many formaldehyde workers, such as: burning of the eyes, lacrimation, and general irritation of the upper respiratory passages. To demonstrate this toxic action of formaldehyde a study was conducted in embalming rooms of funeral homes to determine the concentration and its effect on the embalmers at this level. The control measures in these establishments were also evaluated and found to be inadequate in some respects. Paraformaldehyde powders were sized and found to contain a respirable fraction. The results of the study show that these workers verified the fact that formaldehyde is an irritant at levels that are below the present Threshold Limit Value.

Air Pollutants, Occupational↗
PubMed2002

Ultrasound guidance for the psoas compartment block: an imaging study.

UNLABELLED: We conducted this study to develop an ultrasound-guided approach to the psoas compartment and to assess its feasibility and accuracy by means of computed tomography (CT). Two examiners performed ultrasound-guided approaches at three levels (L2-3, L3-4, and L4-5) on 10 embalmed cadavers, which were seated prone. After each needle had been advanced into the psoas compartment under ultrasound guidance, the positions of their tips were computed by using two coordinates (A and B). Subsequently, axial transverse CT scans were made to verify the ultrasound measurements by using the same coordinates. In total, 48 approaches were performed (Examiner 1, n = 20; Examiner 2, n = 28). CT revealed that 47 of 48 ultrasound-guided approaches were performed exactly. In 1 of 48 approaches (L3-4), the tip of the needle was located posterior to the psoas muscle. The median differences between ultrasound and CT coordinates were 0.3 plus minus 0.3 cm for A and 0.2 plus minus 0.3 for B. Kendall's coefficient of concordance was 0.9 (P < 0.001) between ultrasound and CT measurements for both coordinates. These results indicate that ultrasound enables exact needle placement, as proved by CT. We conclude that ultrasound guidance might be a useful adjunct to increase the safety and efficacy of the psoas compartment block at these levels. IMPLICATIONS: We developed an ultrasound-guided approach to the psoas compartment at the levels L2-3, L3-4, and L4-5. Feasibility and accuracy were tested on embalmed cadavers and verified by means of computed tomography. Ultrasound guidance proved to be feasible and accurate for the performance of psoas compartment blocks.

Aged↗
PubMedDate not supplied

Biomechanical evaluation of the dynamic hip screw with two- and four-hole side plates.

OBJECTIVES: To determine the biomechanical strength and stiffness of a dynamic hip screw (DHS; Synthes USA, Paoli, PA, U.S.A.) with a two-hole side-plate as compared with a four-hole side-plate design for the reconstruction of unstable three-part intertrochanteric fractures. DESIGN: Eight matched pairs of embalmed human femurs were tested in two modes: (a) 2,000 cycles of simulated physiologic loading; (b) test to failure. SETTING: Laboratory. Simulated single leg stance using a simulated pelvic loading mechanism with abductor loading. Strain and displacement sensors were used to measure fragment shear and distraction and surface strain in the proximal side plate. SPECIMENS: Eight pairs of skeletonized embalmed cadaveric specimens were selected on the basis of femoral neck angle and absence of old fracture, anatomic anomaly, or pathology. INTERVENTION: The specimens were divided into two groups: (a) left femurs received the two-hole side-plate design; (b) right femurs received the four-hole side-plate design. All fractures were reconstructed by the same surgeon using the manufacturer's instructions. MAIN OUTCOME MEASUREMENTS: Implant placement was verified by radiographic measurement of tip-to-apex distance. In cyclic testing, the amount of femoral neck fragment migration in both distraction and shear was quantified. Strain magnitude in the side plate was measured in both cyclic and failure testing. The peak load withstood by the reconstruction was quantified in the failure test. RESULTS AND CONCLUSIONS: Peak load in the failure test was not found to be statistically different between the two-hole and four-hole designs. In cyclic testing, the two-hole configuration exhibited statistically smaller fragment migration in both shear and distraction than the four-hole design (p < 0.05). The strain magnitude in the side plate was not statistically different in the cyclic or failure tests. The femurs with a greater neck angle failed by crushing of the bone in the neck. The femurs with a lesser neck angle failed due to bending of the hardware. The results of this investigation revealed that the two-hole DHS is biomechanically as stable as the four-hole DHS in cyclic and failure loads under the conditions tested. These results, in concert with clinical experience, can be used to support the use of the two-hole DHS for the reconstruction of intertrochanteric fractures without a diaphyseal extension.

Adult↗
PubMed1994

Clinical implications of the surgical anatomy of the sural nerve.

The exact anatomy of the sural nerve remains important for many clinical situations. To better understand this anatomy, 25 embalmed and 10 fresh cadaver pairs were studied. The origin of the common sural nerve in relation to the fibular head and its medial and lateral sural components were investigated. The lateral sural nerve was absent in 4 percent of the embalmed cadavers. The lateral and medial sural nerves united in the popliteal fossa in 12 percent and in the lower third of the leg in 84 percent of the cadavers. A site was identified where the lateral sural and lateral cutaneous nerve of the calf pierced the deep fascia. This site was centered about the fibular head and may be viewed as a potential site of nerve compression. There is application of these findings to nerve grafting, neuroma prevention and treatment, and sural nerve biopsy.

Humans↗
PubMed1997

The peritoneal free flap: an anatomic study.

In view of a possible clinical application of an isolated microvascular peritoneal flap, an anatomic study was performed in order to determine the peritoneal vascular territory of the deep inferior epigastric artery. For this, the deep inferior epigastric artery was injected unilaterally with Araldite in 30 embalmed cadavers and bilaterally with india ink in 15 fresh cadavers. In 70 percent of the embalmed cadavers, a constant pattern of three branches from the deep inferior epigastric artery could be identified. The peritoneal vascular supply is not derived solely from these three branches but also from multiple small branches sprouting directly from the main stem of the deep inferior epigastric artery and from segmental and muscular branches. Therefore, classification of peritoneal branches arising from the deep inferior epigastric artery seems to be of little clinical importance. In all cases, the india ink injected in the deep inferior epigastric artery colored a similar territory of the parietal peritoneum. Considering the magnitude of the peritoneal vascularization by the deep inferior epigastric artery, implementation of an isolated free or pedicled peritoneal flap seems to be possible. Such a microvascular peritoneal flap vascularized by the deep inferior epigastric artery may be used, for example, for reconstruction of mucosal defects in the head and neck region.

Epigastric Arteries↗
PubMed1996

An anatomic evaluation of L5 nerve stretch in spondylolisthesis reduction.

STUDY DESIGN: Lumbosacral spondylolisthesis was simulated using four embalmed human spines, and the path of the L5 nerve was studied. OBJECTIVES: To quantify the change in length of the L5 nerve root associated with reduction of spondylolisthesis, correction of slip angle, and changing disc height. SUMMARY OF BACKGROUND DATA: Stretch injury to the lumbar nerves remains a complication of spondylolisthesis reduction. To date, no anatomic studies have been performed to quantify this effect of reduction on the lumbar nerves. METHODS: The L5 vertebral body and the sacrum of four embalmed human spines were constrained in an adjustable jig, and the length of a simulated nerve was determined for various position variables--sagittal translation (0-100% slip), slip angle (-40 degrees to +20 degrees), and disc height (5 or 10 mm). Two standard points of reference were chosen to represent fixed points along the path of the L5 nerve. An inelastic cord was used to measure the path length between these points as L5 was reduced from 100% to 0% slip. Testing was performed using a 5-mm and a 10-mm disc height. The effect of varying slip angle alone was also studied. RESULTS: The effect of spondylolisthesis reduction and slip angle correction on nerve length varied depending on the location of L5 with respect to the sacrum. There was an increasing effect of partial reduction on nerve length as L5 approached full reduction. Initially, little strain was produced in the L5 nerve as L5 was reduced in higher grade slips. However, as L5 approached full reduction, the strain per increment of reduction increased rapidly. On average, the mean nerve strain was 4.0% for the first 50% of reduction and 10.0% for the second half of reduction. Increasing lordosis relaxed the nerve in high-grade slips and stretched the nerve in fully reduced slips. At 100% slip, the mean nerve excursion decreased 5.1 mm (nerve slackening) when L5 was rotated from +20 degrees to -40 degrees. At 0% slip, the mean nerve excursion increased 3.1 mm (nerve stretch). Increasing disc height directly stretched the L5 nerve. However, given a larger disc height, the strain on the nerve per increment of reduction was less than for the smaller height. CONCLUSION: The findings suggest that the risk of stretch injury to the L5 nerve with reduction of a high-grade spondylolisthesis is not linear; with 71% of the total L5 nerve strain occurring during the second half of reduction, partial reduction may be a significantly safer treatment approach for high-grade spondylolisthesis than complete reduction. Correction of lumbosacral kyphosis in high-grade spondylolisthesis may be protective of the L5 nerve.

Cadaver↗
PubMed1996

Anatomy of the retroperitoneum: observations of the distribution of pathologic fluid collections.

PURPOSE: To correlate anatomic dissections with clinical observations regarding anatomic distribution of retroperitoneal fluid, and to document the existence of planes that lie between classically described retroperitoneal spaces. MATERIALS AND METHODS: Latex was injected in varying amounts into the pancreatic tail in three fresh cadavers to simulate peripancreatic fluid collections. Spiral computed tomography (CT) was performed of the abdomen and pelvis after each latex injection. Two cadavers were subsequently frozen and sectioned in axial planes; limited dissections were performed on these specimens. One was embalmed and underwent extensive anatomic dissection. Five embalmed, unprepared cadavers were also dissected to confirm observations made in the three prepared cadavers. RESULTS: Latex injected into the tail of the pancreas entered a retromesenteric plane that was posterior to the anterior pararenal space and anterior to the anterior renal fascia. The plane continued superiorly, extending to the diaphragm near the esophageal hiatus; inferiorly, extending to the pelvis along the anterolateral surface of the psoas muscle; and laterally, posterior to the descending colon and its mesentery. The plane also communicated with a retrorenal plane lying between the posterior renal fascia and the posterior pararenal space. CONCLUSION: Embryologic development of the dorsal mesenteries suggests the existence of retromesenteric planes, and clinical observations further support their existence. These findings may explain the observed distribution of retroperitoneal fluid collections from diaphragm to pelvis.

Cadaver↗
PubMedDate not supplied

Gynecomastia in a mortician. A case report.

The fine needle aspiration (FNA) observations in a case of gynecomastia occurring in a mortician are described. The FNA smear showed cytomorphologic features typical of a gynecomastia. Morticians use an embalming cream that contains estrogens or estrogenlike compounds; these substances may be absorbed percutaneously and cause the development of gynecomastia. The mortician should be made aware of the potential risk of such an occupational exposure and development of the "embalmer's curse. "Recognition by the clinicians and cytopathologists of such an occurrence and its implications can help with the proper management.

Adult↗