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Phenoxyethanol as a nontoxic preservative in the dissection laboratory.

In an effort to rid the dissection room of irritating and potentially health-threatening toxic chemicals, we have modified the phenoxyethanol technique for long-term preservation of embalmed cadavers. The new methods employ faster, less toxic embalming and reduced or eliminated phenoxyethanol immersions. Our results are comparable with or improved over those previously described and demonstrate that phenoxyethanol is an excellent, easily manageable alternative preservative to standard formaldehyde/phenol-based embalming fluids.

Aged↗

An unusual injury.

The case of a young man who died unexpectedly from myocarditis is presented. The body was partially embalmed before autopsy at the Victorian Institute of Forensic Pathology. Although the cause of death was not a problem to diagnose, this case highlights artefacts that embalming may cause and the difficulties it may create with interpretation of injury. This is of particular relevance to those forensic pathologists who only uncommonly see injuries which are due to embalming.

Adolescent↗

[A sketch of history of the European tanatopraxis].

Tanatopraxis is an intentional action aiming to stop all the processes, which lead to a complete decomposition of a body after death. The words embalmment or mummification makes us think about cultures of the ancient Egypt or pre-Columbian America and not about burials of Indo-European nomads or Chinese aristocrats. Meanwhile practices aiming to protect mortal remains against a destructive force of death were known in Europe very long ago. We can see it in paludal burials of the Iron Age and in some testimonies of the ancient epochs. Interventions, which could materially retard decomposition of a body, had been rather generally practiced from the Middle Ages. More practical than religious reasons justified it, but the latter cannot be overlooked. The religious background of such actions can be seen in the custom of embalming mortal remains of popes or kings of France. It was in Europe where the preservation of crops had started to be treated as a scientific problem, and we can see it for the first time in the Renaissance. Together with a development of medical knowledge and especially of anatomy and preparations, a great progress both in methods and substances used for embalming, took place. Ruysh and Holmes in the 17th century, the Hunter brothers in the 18th century and Gannal and Holmes in the 19th century are the milestones in the history of tanatopraxis in Europe. Foundation of the French Institute of Tanatopraxis (IFT) has crowned the many hundred years old experience in the field.

Death↗

Recognition of cemetery remains in the forensic setting.

Cemetery remains exposed through vandalism or natural phenomena are frequently brought to the attention of law enforcement agents or medical examiners. Although it is often difficult to distinguish cemetery remains from those of medicolegal significance, clues to their origin may exist. Characteristics consistent with cemetery remains include physical characteristics associated with the embalming process. Characteristics indicative of cemetery remains include functional or ornamental artifacts associated with the coffin, devices used in embalming the body, and elevated levels of embalming chemicals in the soft tissue.

Burial↗

Teaching anatomy with surgeons' tools: use of the laparoscope in clinical anatomy.

The purpose of this study was to establish the feasibility of laparoscopy in embalmed cadavers to teach abdominal gross anatomy. One cadaver was selected based on body habitus and absence of previous abdominal operations. A standard trocar was used to enter the abdomen at the umbilicus. Two trocars were placed in the left upper quadrant. Pneumoperitoneum was achieved with continuous CO(2) pressure. Liver retraction was achieved percutaneously, exposing the porta hepatis and the gallbladder. The dissection was done with four first-year medical students using standard laparoscopic equipment. Following this, the demonstration was projected over multiple monitors so that all students could participate. Laparoscopic dissection in an embalmed cadaver is feasible and an excellent educational tool for both the medical student and the dissector. The dissector has the opportunity to manipulate laparoscopic tools in a human model closely paralleling operative experience, and the students have an opportunity to learn abdominal anatomy from a clinical perspective. Laparoscopic examination and dissection of fresh cadavers has been used for training surgeons on new procedures such as colon resection, antireflux procedures, and cholecystectomy. There is no report of this same technology used in embalmed cadavers to teach basic anatomy. This approach allows first-year medical students to learn the anatomy while exposing them to the technology currently used in surgical practice, and it affords surgical residents and students additional opportunities to practice laparoscopic skills.

Abdomen↗

Fracture of the acetabulum during insertion of an oversized hemispherical component.

A hemispherical metal-backed acetabular component that was oversized by two or four millimeters was introduced without cement into thirty fresh or embalmed cadaveric acetabula that were fifty, fifty-two, fifty-four, fifty-six, or fifty-eight millimeters in diameter. Manual tapping was used to insert the component into ten fresh and ten embalmed specimens, and a materials testing machine was used for the remaining five fresh and five embalmed specimens. The magnitude of force and the number of pulses necessary to seat the component were determined for the insertions performed with the materials testing machine; 2000 and 3000 newtons of force were required to insert the cups that were oversized by two and four millimeters, respectively. Visual and radiographic assessments were used to identify any resulting acetabular fractures. Over-all, eighteen (60 per cent) of the thirty acetabular specimens fractured. Of the eighteen fractures, only fifteen were detectable radiographically: ten on en face or lateral radiographs of the cup and five only on oblique radiographs of the cup. The remaining three fractures were apparent only after the removal of the acetabular component.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗

Posterior-anterior glide of the femoral head in the acetabulum: a cadaver study.

STUDY DESIGN: Descriptive study employing cadaver dissection and measurement of posterior-anterior (PA) glide of the femoral head in the acetabulum. OBJECTIVE: To quantify PA glide of the femoral head in the acetabulum in a cadaveric sample. BACKGROUND: Posterior-anterior glide of the femoral head within the acetabulum is a joint mobilization procedure described in orthopaedic physical therapy texts, yet there is no published evidence that the joint structures of the hip allow such movement. This study attempted to quantify PA glide of the femoral head in the hip joints of embalmed cadavers. METHODS: Twelve hips, 3 male and 9 female, from 8 embalmed cadavers were employed in this study. Hips were dissected to the level of the joint capsule and a metal rod inserted through the femoral neck served as a mobilizing handle. A load cell was installed into this handle so that mobilizing forces could be monitored. A dial gauge, which recorded displacement of the femoral head, was mounted to the pelvis via bone pins and an external fixator. RESULTS: Using mobilizing forces of 89, 178, 267, and 356 N, mean femoral head displacements of 0.57, 0.93, 1.20, and 1.52 mm were recorded. Within the 89-N trials, PA displacement ranged from a minimum of 0.04 mm to a maximum of 1.54 mm. Within the 356-N trials, PA displacement of the femoral head ranged from a minimum of 0.25 mm to a maximum of 2.90 mm. CONCLUSION: In an embalmed cadaveric model, measurable PA glide of the femoral head within the acetabulum does exist and it is highly variable between individuals.

Acetabulum↗

[Preservation of cutaneous structures of egyptian mummies. An ultrastructural study].

INTRODUCTION: The recent development of studies applied to ancient materials may be explained by the application of molecular biology techniques on the extracted ancient DNA mainly the polymerase chain reaction (PCR), the ultrasensitive DNA-amplification technique that hit the headlines in the late 1980s. PCR was used to amplify human immunodeficiency virus (HIV), genetic material in stored tissue specimens and to document people who died in 1976. In addition, recent discoveries of mummified bodies in ice of the Tyrolean Alps or Greenland allowed a new approach in archeological studies. Mummies are a good material for investigations of ancient tissues. The studies concern the techniques of embalming, tissue preservation and palepathological aspects. In cutaneous paleopathology, mummies from Egypt, South or North America and Europe were considered. Various skin lesions were characterized: histiocytoma, Chagas' disease, smallpox, syphilis. Recently drugs (cocaine, hashish and nicotine) were extracted from skin and head hair of Egyptian mummies. Only a few studies were concerned with the ultrastructure of the skin of such mummies. MATERIAL AND METHODS: We had the opportunity to obtain skin samples of two Egyptian mummies. One of them was embalmed between 150 BC-90 AC. The skin was studied by transmission electron microscopy. As the mummified materials had dried out and shrunk, it was necessary to rehydrate them for ultrastructural observation. Skin samples were fragmented into small pieces before fixation with 2 p. 100 glutaraldehyde in sodium cacodylate buffer for 10 days (allowing for removal of the materials used for embalming). The samples were then washed in the same buffer for 10 days. After washing the pieces were post-fixed with 1 p. 100 osmium tetroxyde, dehydrated and embedded in Epoxy medium. RESULTS: With this process, it was possible to observe the excellent preservation of the cutaneous structures. The epidermis was well preserved. It was possible to observe the different cell layers and mainly the upper layers. The nuclei and the desmosomes of keratinocytes were recognized. Intercellular spaces were narrow. Desmosomes showed dense thickenings of the cell membrane on both sides and an intercellular band with narrow lucent spaces adjacent to the dense cell membrane. The nuclei showed dense spots of chromatin and in the cytoplasm recognizable tonofilament bundles were identified. Langerhans cells and melanocytes were not observed. In the dermis, the collagen fibrils formed thick bundles and showed the characteristic axial periodicity. Elastic fibers were also recognized showing two main components: the amorphous substance and the fibrils. Throughout the dermis, a number of round or oval structures were found. They had the typical appearance of spores of bacteria. In the centre, they had an electron dense and granular core surrounded by an inner membrane and a spore coat. DISCUSSION: Only a few investigations were performed on the ultrastructure of the skin of the Egyptian mummies. In the majority of cases, the epidermis was not preserved. The present work demonstrates the good preservation of epidermal structures and specially desmosomes and intercellular connections. The presence of spores of bacteria was previously reported. These spores enter a highly resistant resting phase in order to survive in a dormant state for a long period of starvation or other adverse environmental conditions. Similar investigations were performed on skin obtained from Eskimo mummies preserved by the extremely cold and dry polar weather. In these conditions, the authors reported the observation of melanocytes, vessels and nerves. Additionally, biochemical investigations demonstrated the very good preservation of collagen and glycosaminoglycans of the dermal extracellular matrix.

Collagen↗

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↗

Stability study of fluoxetine in formalin-fixed liver tissue.

In the present work, we report conversion of fluoxetine (Prozac), a novel anti depressant to N-methyl fluoxetine in formalin fixed liver tissue. Earlier studies indicate that drugs containing secondary amino group will react with formalin to form corresponding N-methyl derivatives. Even though embalming cadavers is common, it may create problems for forensic toxicologists if a case was not previously suspected. In formalin solutions, fluoxetine is methylated producing N-methyl fluoxetine. N-Methyl fluoxetine standard was synthesized by treating fluoxetine in formaldehyde solution. The structure confirmed by (1)HNMR and gas chromatography-mass spectrometry in electron impact ionization mode. Randomly chosen rat liver pieces (200-250 mg) were injected with 100 microg of Fluoxetine. The liver pieces were covered with three different concentrations of formalin, 5%, 10%, and 20%, and at three different pHs, 3.0, 7.0, and 9.5. The reaction was studied for a total period of 30 days, and the reaction products were monitored on days 0, 4, 14, and 30 days. The study indicates that the rate of conversion of fluoxetine to its N-methyl derivative increased with increase in the concentration of formalin and pH of the solution. The conversion is rapid at higher pH values. Fluoxetine was totally converted to its N-methyl derivatives after 30 days in 20% formalin at pH 9.5. Therefore, analysis for parent drug or its N-methyl derivative in embalmed tissues may provide data that will reduce the likelihood of false negatives.

Animals↗

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↗

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↗

MR imaging visualization of the cerebral microvasculature: a comparison of live and postmortem studies at 8 T.

SUMMARY: In this study, we compared 8-T gradient-echo MR images of the microvasculature in the live human brain with images of the unembalmed and embalmed postmortem brain. Small vessels were well visualized in the live brain and even better seen in the unembalmed postmortem brain, but they could not be visualized in the embalmed postmortem brain. These findings are important for direct comparisons of the microvasculature on 8-T MR images and on histologic sections.

Aged↗

[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↗

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↗

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↗

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↗

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↗