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[The first Nassaus in The Netherlands: identification of and paleopathological findings in Willem van Oranje's ancestors, buried in the Grote Onze Lieve Vrouwe Kerk in Breda].

OBJECTIVE: Identification and paleopathological analysis of the remains of the first members of the Nassau dynasty in the Netherlands. DESIGN: Descriptive. SETTING: Centre for Physical Anthropology 'Barge's Anthropologica', Leiden University. METHODS: In 1996, seven interments were discovered in situ in a tomb under the Nassau monument of the so-called 'Grote' or 'Onze Lieve Vrouwe' Church of the city of Breda. The interments were excavated and examined by osteological analysis, X-ray analysis, accelerator mass spectrometry (AMS) 14C dating of bone and dendrochronological dating. RESULTS: Evaluation of archaeological, osteological, dendrochronological and AMS 14C-dating data resulted in identification. in order of death, of: Engelbrecht I van Nassau (ca. 1370-1442 AD), Johanna van Polanen (1392-1445 AD), Jan IV van Nassau (1410-1475 AD), Cimburga van Baden (1450-1501 AD), Maria van Loon (1425-1502 AD), Engelbrecht II van Nassau (1451-1504 AD) and Françoise van Savoye ((1480-1486)-1511 AD). Remarkable medical findings were: embalming procedures employed (skull cap detachment, removal of viscera), treponematosis (Engelbrecht II), tumour metastases (Jan IV) and scoliosis (Françoise van Savoye). CONCLUSION: The methods employed resulted in positive identification of the first members of the Nassau dynasty in the Netherlands and diagnoses of their paleopathological changes.

Embalming↗

Production of spiral fractures in human cadaver long bones by use of a simple torsion machine.

A simple machine was developed so that long bones could be torqued to failure in order to estimate applied moment and study the resulting spiral fracture pattern. Detailed study of the fragments enabled the postulation of an orderly manner of fracture propagation. Twenty-seven embalmed human cadaver femurs were studied. The machine held one end of the bone in a fixed vise and the other in a rotating vise. Spring scales were used to apply force to a bar connected to the rotating vise which allowed for a crude estimation of torsional moment. Male femurs (72.8 yrs old sigma = 11.4) fractured at a mean torque of 106.7 N-m (sigma = 23.8), while female femurs (78.0 yrs old sigma = 6.7) failed at a mean torque of 96.7 N-m (sigma = 39.4). There were no statistically significant differences between the ages (p = 0.20) or the torsional moments at fracture (p = 0.41) for the male and female femurs. Given the similarities in this study population, an eye was turned towards anthropomorphic measurements in order to determine factors that might be indicative of bone strength. Several measurements were made on the fragments especially in the midshaft region. These included six cortex thicknesses, bone depth, width and circumference. Simple statistical analyses were performed.

Aged↗

Surgical anatomy of septorhinoplasty.

Anatomic studies of the nose were done in 60 cadavers, both fresh and embalmed, allowing correlation of surgical anatomy and operative techniques. All septorhinoplasties were performed on fresh cadavers, using a clinical instrument set and head lamp. In addition, the alar cartilages were assessed in 25 patients undergoing external rhinoplasty. This multifaceted study provided an integrated approach to nasal anatomy.

Esthetics↗

Vascularized bone flaps in oromandibular reconstruction. A comparative anatomic study of bone stock from various donor sites to assess suitability for enosseous dental implants.

OBJECTIVE: To identify donor sites from which vascularized bone may be harvested capable of accepting osseointegrated implants of the minimum dimensions required to ensure long-term implant stability. DESIGN: An anatomic study of the most commonly employed donor sites for vascularized bone in oromandibular reconstruction was conducted on 28 cadavers. SETTING: Academic tertiary referral center. PARTICIPANTS: Twenty-eight freshly embalmed, adult white cadavers (16 male, 12 female) were dissected. INTERVENTION: The ipsilateral fibula, iliac crest, radius, and lateral border of the scapula were harvested and multiply sectioned at predetermined sites. OUTCOME MEASURE: Implantability was determined for each section based on measurements of height, width, and cross-sectional area utilizing computer planimetry. RESULTS: The iliac crest was the most consistently implantable donor site, followed by the scapula, fibula, and radius (83%, 78%, 67%, and 21% of sections from each donor site satisfying the criteria for implantability). Consistent regional differences in implantability were encountered at each donor site except the scapula. CONCLUSIONS: Following ablation of oromandibular malignant neoplasms, restoration of stable retentive dentition is a prerequisite to a successful functional oral rehabilitation. This is best achieved with enosseous implants, capable of supporting a stable dental prosthesis, placed directly into vascularized bone flaps at the time of mandibular reconstruction. The implications of the results obtained in this study for gender, donor site selection, and orientation of the vascularized bone flap are discussed.

Aged↗

Iliosacral screw insertion using computer-assisted CT image guidance: a laboratory study.

Procedures were performed to evaluate the efficacy of using a computer-assisted image-guided system to improve the accuracy of inserting iliosacral screws for posterior pelvic ring injuries. The fluoroscopic method currently in use has shortcomings that do not eliminate the risk to the L5 and sacral nerve roots and iliac vessels. The procedure was performed on embalmed cadaver pelvis specimens with intact soft tissues. Iliosacral screws were inserted across each sacroiliac joint after registering the opposite ilium to simulate a clinical situation. Two trials were performed. The first was necessary to become familiar with the system and test the basic methods of registration. In the second trial, deficiencies were corrected by using spherical-headed fiducial screws for fiducials and a better reference frame clamp, and by better spacing of more fiducials. Results were evaluated by inlet and outlet X-ray views and dissection. All eight S-1 iliosacral 7.0-mm cannulated screws were entirely inside bone. Of the eight S-2 screws, five were inside bone, two infringed upon an S-1 foramen, and one had threads out of the sacral body anteriorly and intruding into an S-1 foramen. This system was felt to be effective and sufficiently safe to warrant clinical trials.

Bone Screws↗

An injectable cementing screw for fixation in osteoporotic bone.

With the aging population, osteoporosis and osteoporotic fractures are becoming more prevalent. Adequate screw fixation in this type of bone is difficult. Screws are often cemented in bone to help obtain purchase. However, current cementing techniques do not ensure implant stability. Here we present a new cannulated screw with side ports that can be injected with polymethylmethacylate (PMMA) for fixation in osteoporotic bone. We compared the ultimate holding power of this cannulated screw injected with PMMA to a solid screw with the same dimensions secured with PMMA by the standard technique. Both screws were placed into embalmed and fresh frozen lumbar vertebral bodies and pulled out using a mechanical testing system. The cannulated screw had a 278% greater holding power compared to the standard screw (p < 0.006). The cannulated screw provided a significant increase in holding power in osteoporotic bone. This novel screw is promising for fixation in osteoporotic bone and warrants clinical evaluation.

Aged↗

The communicating branch of the lateral plantar nerve: a descriptive anatomic study.

Since the communicating branch of the lateral plantar nerve has been implicated as a factor in the etiology of Morton's neuroma, a painful perineurofibrosis of a common plantar digital nerve, this project was designed to investigate the anatomy of this communicating branch. Both feet of 40 embalmed human cadavers were dissected to show the frequency of occurrence and anatomical variation of the communicating branch. The communicating branch was present in 66.2% of the feet we studied with no large gender-based differences. Branches occurred bilaterally in 52.5% of cadavers, while 27.5% had branches unilaterally. The occurrence of this branch does not correlate well with the likelihood of development of Morton's neuroma. Differences in diameter of the communicating branch ranged from less than 0.5 mm to as large as the common plantar digital nerves themselves, about 2 mm. The presence or absence of the communicating branch made no qualitative difference in the diameters of the common plantar digital nerves. There were 60.4% of the communicating branches in this study that had a typically-described orientation, arising more proximally in the foot from the fourth common plantar digital nerve, while 39.6% of the branches had a reversed orientation, arising more proximally from the third common plantar digital nerve. These reversed branches had a more oblique orientation when compared to the classic branches. Other anatomical variations were noted, including accessory branches that attached to deeper structures in the foot. These data form a basis for further research into the etiology of Morton's neuroma and improved surgical techniques for correcting this condition.

Adult↗

Gross anatomic evidence of partitioning in the human fibularis longus and brevis muscles.

Evidence from a variety of studies suggests that many mammalian muscles are partitioned with respect to their architecture and innervation. Each of these specific muscle subvolumes is innervated by an individual muscle nerve branch, contains motor unit territories with a unique array of physiological attributes and has been known as a neuromuscular compartment or segment. This gross anatomic study investigated for evidence of neuromuscular segmentation in human fibularis (peroneus) longus and brevis muscles. Forty-three legs (24 left, 19 right) from embalmed adult cadavers were dissected. Any architectural segment within these muscles were identified. The specific innervation patterns of these muscles were also described. The fibularis longus muscle was consistently found to have connective tissue partitions that separated it into four parts: anterior superficial, anterior deep, posterior superficial, and posterior deep. The innervation pattern of this muscle was consistent with the segments defined by the connective tissue partitions. There were consistently four primary motor branches, each supplying a specific portion of the fibularis longus muscle. While a typical branching pattern was recognized, there was some variability as to the order of these branches as they originated. The fibularis brevis muscle was consistently found to have a central connective tissue partition that separated it into two portions: anterior and posterior. In 91% of the fibularis brevis muscles, there were two primary motor branches, one for each of the two segments of the muscle. In the other 9%, only one primary motor branch supplying the muscle could be identified.

Adult↗

Anatomical study of the synovial plicae of the hip joint.

Observations and measurements of the synovial plicae of the hip joints were made on 63 embalmed cadavers. The cadavers were divided equally among three age groups (fetuses, children, and adults). Our observations showed that the plicae appeared in two forms (flat and villous) and were mainly confined to the external surface of the lower medial part of the acetabular labrum (labral plicae), the base of the ligament of the head of the femur (ligamental plicae), and along the reflecting line of the synovial membrane on the base of the femoral neck (neck plicae). The ligamental plicae were well padded with a fibroelastic pad of fat filling the acetabular fossa, and the neck plicae were far away from the articular surfaces of the joint; as a result, neither was likely to be injured or entrapped during joint movements. The labral plicae were larger than the ligamental or neck plicae and had an incidence of 73.8% in the fetal group. The fetal plicae were found only after the fetal age of 5 months. In nine cases of the child and adult groups, the labral plicae extended between the articular surface of the femoral head and the lower part of the acetabulum during medial rotation of the thigh. When the thigh was rotated laterally, the plicae in six of the same cases could be returned to their original positions. In the remaining three cases, there was continual impingement.

Adolescent↗

Biometry of the muscular branches of the median nerve to the forearm.

The aim of this study was to determine the biometry of the muscular branches of the median nerve to the forearm in ten embalmed upper limbs. We measured the length of the forearm and the level of origin of each muscular branch of the median nerve to the forearm from the middle of a line between the medial and lateral epicondyles. The level of origin of each branch was then calculated as a percentage of the length of the forearm. Mean length of the forearm was 25 +/- 2.36 cm (range: 22-29 cm). Although the levels of origin of the proximal and distal nerves to pronator teres, and of the nerves to palmaris longus, flexor carpi radialis and flexor digitorum superficialis, were quite variable (coefficient of variation: CV > 48.61%), the level of origin of the anterior interosseous nerve (CV = 31.24%) and its branches (nerves to flexor pollicis longus and flexor digitorum profundus, CV = 20.06%) was less variable. These results suggest that the anterior interosseous nerve of the forearm is probably the nerve to connect in muscular free transfers in order to restore flexion of the fingers after damage to the flexor tendons to the forearm. We observed Martin-Gruber communications in six out of ten dissections.

Aged↗

Anatomy of the ulnar nerve at the elbow: potential relationship of acute ulnar neuropathy to gender differences.

Men develop perioperative ulnar neuropathies more frequently than women. To determine the role of anatomical gender differences in the development of these neuropathies, we performed several studies of the anatomy of the ulnar nerve, cubital tunnel, and elbow region. These studies included detailed dissection of male and female embalmed and unembalmed cadavers, ultrasound measurements of the tissue layers at the elbow, and measurement of various dimensions of the coronoid process of the ulna in multiple skeletal sets. No gross anatomical differences were found between genders regarding the course of the ulnar nerve through the upper limb. However, there was a strikingly larger (2-19 times greater) fat content on the medial aspect of the elbow in women compared to men, and the tubercle of the coronoid process was approximately 1.5 times larger in men (P < or = .002, rank sum test). Our finding suggest that the tubercle of the coronoid process is a likely area for external compression-induced ischemia of the ulnar nerve because the nerve and its arterial supply (the posterior ulnar recurrent artery) are covered at the tubercle only by skin, subcutaneous fat, and a very thin aponeurosis of the flexor carpi ulnaris. Importantly, this tubercle is larger and the nerve and blood vessels passing by it are less protected by subcutaneous fat in men than in women. These two anatomical differences between men and women may contribute to the increased frequency of perioperative ulnar neuropathy induced by external pressure at the medial aspect of the elbow in men.

Cadaver↗

Bilateral double axillary artery: embryological basis and clinical implications.

An unusual bilateral variation in the arterial pattern of the axilla was observed in an embalmed cadaver. Each axilla contained two axillary arteries of similar origins but different patterns of branching and fate. The first part of each axillary artery was a single vessel as is the norm. It gave off a supreme thoracic artery and then bifurcated into two medium-sized arteries hence referred to as regular and variant. The variant artery ran in an antero-medial course, partly covered by the one axillary vein. The regular artery gave off the thoracoacromial and two posterior branches from its second part, the anterior and posterior humeral circumflex arteries from its third part, and then continued as the brachial artery with all the usual branches except the profunda brachii on the right side. The variant gave off five arteries from the second part, a thoracoacromial artery, two separate long thoracic arteries each with a branch that ran along the intercostobrachial nerve to the arm, and two posterior branches. In the third part of the variant, the subscapular artery arose with its usual branches plus a common origin for two additional humeral circumflex arteries. The variant terminated as the profunda brachii artery to the right side while on the left side it terminated in muscular branches to the triceps. Hence, the arterial blood supply to the upper limb, and the axillary region in particular, was shared on both sides by two major arteries instead of one. These two arteries emanated from the first part of the axillary artery and may represent persisting branches of the capillary plexus of the developing limb buds. The findings have an embryological basis and clinical relevance considering the frequency of procedures in this region.

Aged↗

Evaluation of risks for non-Hodgkin's lymphoma by occupation and industry exposures from a case-control study.

The etiology of non-Hodgkin's lymphoma (NHL) is not well understood. To develop hypotheses on causes of this tumor, data from a population-based case-control interview study of 1,867 white men (622 cases and 1,245 controls) in Iowa and Minnesota conducted during 1980-1983 were examined. Subjects, or their next of kin, were interviewed to obtain information on agricultural exposures, work history, medical conditions, and family history. This analysis focuses on risks of NHL by occupation, by industry, and by selected exposures. Although many comparisons were made, few significant associations were observed. Small numbers and limitations in exposure assessment, however, would tend to reduce opportunities to detect associations. The strongest finding was with various occupations that work in metals and metal products. The analysis by exposure estimates also uncovered a significant association with metals, but risks did not increase with estimated intensity of exposure. Slightly elevated risks were also noted among persons employed as painters and construction workers, agricultural and forestry workers, printers and typesetters, funeral directors and embalmers, and dry cleaners. Although the overall risks for benzene and other solvents were small, they increased slightly with level of assigned exposure. Although some associations may be due to chance, several of these occupations and industries have been linked to lymphoma in other investigations and deserve further attention.

Adult↗

Julia Pastrana, the nondescript: an example of congenital, generalized hypertrichosis terminalis with gingival hyperplasia.

Julia Pastrana (1834-1860) has gained immortality as one of the most extreme cases of generalized hypertrichosis upon record. When she was exhibited for money in the United States and Europe during the years 1855-1860, people thronged to see her, and she was several times described in the medical press of the day. After Julia Pastrana's death in childbirth, her corpse was embalmed in a very life-like manner, and exhibited all over Europe for several decades. Later, the mummy was believed to be lost, but in 1990 it was discovered at the Oslo Forensic Institute. Some writers have included Julia Pastrana among the cases of congenital hypertrichosis languinosa. However, a microscopic examination of hair samples from the mummy shows that her hairy growth is unmistakably terminal in character, and we propose that she instead was an example of congenital, generalized hypertrichosis terminalis with associated gingival hyperplasia. While many earlier writers have asserted that Julia Pastrana's dentition was abnormal, a radiographic examination of the mummy has shown that she had a complete permanent dentition.

Face↗

Mechanical properties and histology of cortical bone from younger and older men.

Tensile breaking load, strength, strain, modulus of elasticity and density plus the histological structure at the fracture site, were determined for 207 standardized specimens of cortical bone from the embalmed femur, tibia, and fibula of 17 men from 36 to 75 years of age. The men were divided into a younger group (41.5 years old-avg)) and an older group (71 years old-avg). Specimens from younger men had a greater average breaking load, strength, strain, modulus and density than those from older men. The percentage of spaces in the break area was greater in specimens from older men, but specimens from younger men had a slightly greater percentage of osteons, osteon fragments, and interstitial lamellae. The number of osteons/mm2 and of osteon fragments/mm2 was greater in specimens from older men but the average area/osteon and area/osteon fragment was greater in specimens from younger men. Thus, there are quantitative and qualitative differences in the histological structure of bone from younger and older men. Differences in the tensile properties of bone from younger and older men can be explained by histological differences in the bone.

Adult↗

The preparation of human cross sections.

Technical advances in the field of radiology, especially computerized axial tomography (CAT) scanning, have made gross anatomical cross-sections increasingly important in understanding the relationships of internal structures. Since 1940, the Anatomy Program at the University of Vermont has developed and used cross-sections of the entire human body in teaching predoctoral, postdoctoral, and allied health professionals. This paper describes in detail the process through which specimens are selected, embalmed, frozen, sectioned, and displayed. Kaiserling's Method is used for fixation and preservation of the specimens, which are then housed in appropriate display containers. Specimens prepared over forty years ago in the manner described in this paper are still in use.

Adult↗

Exposure to formaldehyde in anatomy: an occupational health hazard?

The adverse effects of formaldehyde have been discussed very emotionally in public. Anatomists, technicians in histology and embalming laboratories, as well as medical students during their dissection course are all exposed to formaldehyde, which in many situations crosses the threshold for irritation of the eyes and upper respiratory tract. There is no doubt about the acute toxic effects and the occurrence of contact dermatitis caused by formaldehyde. Studies in rats and mice using high concentrations over an extremely long period (which would not be tolerated by humans) resulted in squamous carcinoma of the nose. Epidemiologic studies on the mortality of medical personnel exposed to formaldehyde do not provide sufficient evidence of cancerogenicity. A number of recommendations will be given for defining the exact concentration in a dissecting room or laboratory and for ways of reducing formaldehyde concentrations and thus minimizing adverse health hazards. These data could initiate a discussion among anatomists, and with technicians and students, based on a sound scientific background rather than on emotion.

Anatomy↗

Human abductor pollicis brevis muscle "divisions" and the nerve hila.

The interpretation of neuromuscular impairment may be aided by an analysis of functional anatomic factors. The anatomy of the abductor pollicis brevis (APB), a muscle used for skilled movements, was investigated in 19 embalmed hands, and the muscular divisions joining the common tendon at different sites were reproduced on clear vinyl sheets. The median nerve pathway to thenar muscles was followed to where it divides to the APB nerve and to the sites of the main terminal hila. Transverse (x) and longitudinal (y) muscle axes were established with the aid of landmarks to reproduce the nerve pathway on the skin surface. In the rather thick APB, three groups of six muscular heterogeneous divisions were regularly present. The dorsal aponeurotic expansion of the thumb receives the first group. The second group forms a continuous vertical line from the base to the body of the first phalanx. The outside site of its lateral tubercle takes the central tendon from the penniform third group. Hence, a reverse figure-seven distal insertion can be observed. The deepest medial (V2) and the most superficial lateral (V3) divisions had the highest mean diameters. The APB nerve fell between V2 and V2' and its line of projection supplied a guideline to establish an x axis at the proximal one-third of the muscle. The nerve hila plotted in relation to the x-y axes revealed a mode of location. The classical description of a thin APB muscle, made up of two bellies of parallel fibers seems incorrect. The APB nerve is not found on the deep aspect of the muscle as stated earlier, but within the muscle. The well-innervated muscular divisions point to the possibility of their individual use. The APB neuromuscular projection to the skin should allow more accurate fundamental EMG studies of the thumb and therefore provide a basis for more effective treatment in cases of impaired APB.

Humans↗