Anatomic location of the first dorsal extensor compartment for surgical De-Quervain’s tenosynovitis release:A cadaveric study

BACKGROUND De-Quervain’s tenosynovitis is a disorder arising from the compression and irritation of the first dorsal extensor compartment of the wrist.Patients who fail conservative treatment modalities are candidates for surgical release.However,risks with surgery include damage to the superficial radial nerve and an incomplete release due to inadequate dissection.Currently,there is a paucity of literature demonstrating the exact anatomic location of the first dorsal extensor compartment in reference to surface anatomy.Thus,this cadaveric study was performed to determine the exact location of the first extensor compartment and to devise a reliable surgical incision to prevent complications.AIM To describe the location of the first dorsal compartment in relation to bony surface landmarks to create replicable surgical incisions.METHODS Six cadaveric forearms,including four left and two right forearm specimens were dissected.Dissections were performed by a single fellowship trained upper extremity orthopaedic surgeon.Distance of the first dorsal compartment from landmarks such as Lister’s tubercle,the wrist crease,and the radial styloid were calculated.Other variables studied included the presence of the superficial radial nerve overlying the first dorsal compartment,additional compartment subsheaths,number of abductor pollicis longus(APL)tendon slips,and the presence of a pseudo-retinaculum.RESULTS Distance from the radial most aspect of the wrist crease to the extensor retinaculum was 5.14 mm±0.80 mm.The distance from Lister’s tubercle to the distal aspect of the extensor retinaculum was 13.37 mm±2.94 mm.Lister’s tubercle to the start of the first dorsal compartment was 18.43 mm±2.01 mm.The radial styloid to the initial aspect of the extensor retinaculum measured 2.98 mm±0.99 mm.The retinaculum length longitudinally on average was 26.82 mm±3.34 mm.Four cadaveric forearms had separate extensor pollicis brevis compartments.The average number of APL tendon slips was three.A pseudo-retinaculum was present in four cadavers.Two cadavers had a superficial radial nerve that crossed over the first dorsal compartment and retinaculum proximally(7.03 mm and 13.36 mm).CONCLUSION An incision that measures 3 mm proximal from the radial styloid,2 cm radial from Lister’s tubercle,and 5 mm proximal from the radial wrist crease will safely place surgeons at the first dorsal compartment.

Bridge plating in the setting of radiocarpal instability:Does distal fixation to the second or third metacarpal matter?A cadaveric study

BACKGROUND Radiocarpal dislocations are rare but potentially devastating injuries.Poorer outcomes are associated with inadequate or lost reduction,such as ulnar translocation,but no consensus exists on the ideal fixation technique.Dorsal bridge plate fixation has been described for various settings in the treatment of complex distal radius fractures and can be fixed distally to the second or third metacarpal,but its application for radiocarpal dislocations has not been established.AIM To determine whether distal fixation to the second or third metacarpal matters.METHODS Using a cadaveric radiocarpal dislocation model,the effect of distal fixation was studied in two stages:(1)A pilot study that investigated the effect of distal fixation alone;and(2)a more refined study that investigated the effect of described techniques for distal and proximal fixation.Radiographs were measured in various parameters to determine the quality of the reduction achieved.RESULTS The pilot study found that focusing on distal fixation alone without changing proximal fixation results in ulnar translocation and volar subluxation when fixing distally to the second metacarpal compared with the third.The second iteration demonstrated that anatomic alignment in coronal and sagittal planes could be achieved with each technique.CONCLUSION In a cadaveric radiocarpal dislocation model,anatomic alignment can be maintained with bridge plate fixation to the second metacarpal or the third metacarpal if the described technique is followed.When considering dorsal bridge plate fixation for radiocarpal dislocations,the surgeon is encouraged to understand the nuances of different fixation techniques and how implant design features may influence proximal placement.

Extrahepatic portacaval shunt via a magnetic compression technique: A cadaveric feasibility study

AIM: To explore the anatomical feasibility of portacaval shunt using a magnetic compression technique(MCT) in cadavers.METHODS: Computed tomography(CT) images of 30 portal hypertensive patients were obtained.The diameters of the portal vein(PV),the inferior vena cava(IVC),and distance between the two structures were measured.Similar measurements were performed on 20 adult corpses.The feasibility of portacaval shunt based on those measurements was analyzed.First stage of the extrahepatic portacaval shunt using MCT was performed on five cadavers.Specifically,the PV and IVC were exposed through an abdominal incision of the cadavers.The parent magnet was introduced from the femoral vein and was delivered into the IVC by an anchor wire and a 5F Cook catheter.The daughter magnet was introduced into the PV through the splenic vein using aninterventional guide wire.When the daughter magnet met the parent magnet,they automatically clipped together and the first stage of the portacaval shunt was set up.RESULTS: The average diameters of the PV and the IVC measured from the 30 CT image were 14.39 ± 2.36 mm and 18.59 ± 4.97 mm,respectively,and the maximum and minimum distances between the PV and the IVC were 9.79 ± 4.56 mm and 9.50 ± 4.79 mm,respectively.From 20 cadavers,the average diameters of the PV and the IVC were 14.48 ± 1.47 mm and 24.71 ± 2.64 mm,and the maximum and minimum distances between the PV and the IVC were 10.14 ± 1.70 mm and 8.93 ± 1.17 mm,respectively.The distances between the PV and the IVC from both the CT images and the cadavers were within the effective length of portacaval anastomosis using MCT(30.30 ± 4.19 mm).The PV and IVC are in close proximity to each other with no intervening tissues or structures in between.Simulated surgeries of the first stage using MCT on five cadavers was successfully performed.CONCLUSION: Anatomically,extrahepatic portacaval shunt employing MCT is highly feasible in humans.

3T magnetic resonance neurography of pudendal nerve with cadaveric dissection correlation

AIM: To evaluate the pudendal nerve segments that could be identified on magnetic resonance neurography(MRN) before and after surgical marking of different nerve segments.METHODS: The hypothesis for this study was that pudendal nerve and its branches would be more easily seen after the surgical nerve marking. Institutional board approval was obtained. One male and one female cadaver pelvis were obtained from the anatomy board and were scanned using 3 Tesla MRI scanner using MR neurography sequences. All possible pudendal nerve branches were identified. The cadavers were then sent to the autopsy lab and were surgically dissected by a peripheral nerve surgeon and an anatomist to identify the pudendal nerve branches. Radiological markers were placed along the course of the pudendal nerve and its branches. The cadavers were then closed and rescanned using the same MRN protocol as the premarking scan. The remaining pudendal nerve branches were attempted to be identified using the radiological markers. All scans were read by an experienced musculoskeletal radiologist.RESULTS: The pre-marking MR Neurography scans clearly showed the pudendal nerve at its exit from the lumbosacral plexus in the sciatic notch, at the level of the ischial spine and in the Alcock's Canal in both cadavers. Additionally, the right hemorrhoidal branch could be identified in the male pelvis cadaver. The perineal and distal genital branches could not be identified. On post-marking scans, the markers were used as identifiable structures. The location of the perineal branch, the hemorroidal branch and the dorsal nerve to penis(in male cadaver)/clitoris(in female cadaver) could be seen. However, the visualization of these branches was suboptimal. The contralateral corresponding nerves were poorly seen despite marking on the surgical side. The nerve was best seen on axial T1W and T2W SPAIR images. The proximal segment could be seen well on 3D DW PSIF sequence. T2W SPACE was not very useful in visualization of this small nerve or its branches.CONCLUSION: Proximal pudendal nerve is easily seen on MR neurography, however it is not possible to identify distal branches of the pudendal nerve even after surgical marking.

Pre-fabricated radial forearm phalloplasty with cadaveric bone graft

Phalloplasty is a complex set of procedures used in efforts to improve the anatomical,physiological,and aesthetic deficiencies caused by loss or absence of the penis.Methods have evolved significantly,and the use of free tissue transfer has become common amongst reconstructive surgeons.The inclusion of bone autograft,usually radius or fibula,within the neophallus has caused significant morbidity,and efforts continue to find the optimal solution.We present a novel approach using a pre-fabricated,radial forearm fasciocutaneous free flap containing cadaveric bone graft for phalloplasty following traumatic penis amputation.

Cadaveric bone marrow mesenchymal stem cells:first experience treating a patient with large severe burns

Background:In January 2005,Rasulov et al.originally published"First experience in the use of bone marrow mesenchymal stem cells(MSCs)for the treatment of a patient with deep skin burns".Here,we present the first ever treated patient with cadaveric bone marrow mesenchymal stem cells(CMSCs)in the history of Medicine.Methods:A young man,who severely burned 60%of his total body surface with 30%of full-thickness burns while working with a grass trimmer that exploded,was involved in the study.MSCs were obtained from the bone marrow of a cadaver donor in a routine procurement procedure of CUCAIBA,the Province of Buenos Aires,Argentina,Ministry of Health,Transplantation Agency,cultured,expanded,and applied on the burned surfaces using a fibrin spray after early escharotomy.Results:So far,our preliminary experience and our early results have been very impressive showing an outstanding safety data as well as some impressive good results in the use of CMSCs.Conclusions:Based on al this,we think that improvements in the use of stem cells for burns might be possible in the near future and a lot of time as well as many lives could be saved by many other research teams all over the world.CMSCs will probably be a real scientific opportunity in Regenerative Medicine as well as in Transplantation.

Role of Fresh Cadaver Practice and Jesus Prayers on Daily Base in Innovations of a Difficult Neurosurgical Operation (Craniopagus Separation)

Purpose: Challenging cases in neurosurgery require experience, which is gained by operating on a number of similarly difficult cases. However, even in large population centers, there are extremely rare cases, such as craniopagus twins. In these instances, other case-specific solutions are required which were improved in the course of fresh cadaver practice on daily base. Methods: During a 20-month preparation period by fresh cadavers the surgical strategy was developed step by step, comprising five neurosurgical ideas, facilitated by deep Jesus prayers as a spiritual source. Possible causes of postoperative complications that occured on 33d postoperative day were also analyzed. Results: During surgery, these nuances proved to be useful, which is also reflected by the postoperative clinical results. One of the twins advanced to a GOS score of 5three months after the surgery. The other twin, despite nonsurgical septic complications, continued to progress well, but on postoperative day 33 for seemingly unknown reasons, she suffered a severe cerebral hemorrhage, which significantly delayed her rehabilitation. A thorough revision of the whole process much later revealed a pitfall that could have a role in this complication. Conclusions: The challenging neurosurgical separation of the craniopagus twins was carried out successfully with the help of five novel neurosurgical refinements, which were found during 300 fresh cadaver practices. Mistakes can serve as a lesson. We hope that the procedures developed and the knowledge gained can be applied in the future.

The Versatility of Acellular Fetal Bovine Dermal Matrix for Head and Neck Surgical Reconstruction in Children

Objectives: To describe the versatility of acellular fetal bovine dermal matrix as an alternative to human cadaveric allograft for head and neck reconstructive procedures in children. Study Design: Case series with chart review. Methods: A database of pediatric operative procedures was queried for the use of acellular fetal bovine dermal matrix over a 16-month period. Indications for reconstruction were assessed and initial parental and surgeon satisfaction with the product were noted. Results: During the time period of 3/2012 and 7/2013 a total of 8 reconstructive procedures were performed on pediatric patients using acellular fetal bovine dermal matrix. Indications for use varied and included open and transnasal endoscopic repair of encephaloceles and soft tissue reconstructions including lateral pharyngeal wall repair, cleft palate repair, and facial recontouring operations. Acellular fetal bovine dermal matrix had a subjectively increased ease of use as compared to the surgeon’s prior experience with human cadaveric acellular dermis. Every parent vocalized a greater comfort level with the use of a bovine product over the alternative of human cadaveric tissue. The cost of acellular fetal bovine dermal matrix is slightly lower than the cost of human cadaveric acellular dermis. Conclusions: Acellular fetal bovine dermal matrix appears to be an acceptable alternative to human cadaveric acellular dermis for various forms of head and neck soft tissue reconstruction in children. Further prospective studies are warranted to assess for any differences in the long-term efficacy of this product as compared to other forms of allograft reconstruction.

Lobar lung transplantation from deceased donors: A systematic review

AIM To systematically review reports on deceased-donor-lobar lung transplantation(dd LLTx) and uniformly describe sizematching using the donor-to-recipient predicted-total lung-capacity(pT LC) ratio. METHODS We set out to systematically review reports on ddL LTx and uniformly describe size matching using the donorto-recipient pT LC ratio and to summarize reported oneyear survival data of ddL LTx and conventional-LTx. We searched in Pub Med, CINAHL via EBSCO, Cochrane Database of Systematic Reviews via Wiley(CDSR),Database of Abstracts of Reviews of Effects via Wiley(DARE), Cochrane Central Register of Controlled Trials via Wiley(CENTRAL), Scopus(which includes EMBASE abstracts), and Web of Science for original reports on ddL LTx. RESULTS Nine observational cohort studies reporting on 301 ddL LTx met our inclusion criteria for systematic review of size matching, and eight for describing one-year-survival. The dd LLTx-group was often characterized by high acuity;however there was heterogeneity in transplant indications and pre-operative characteristics between studies. Data to calculate the pT LC ratio was available for 242 ddL LTx(80%). The mean pT LCratio before lobar resection was1.25 ± 0.3 and the transplanted pT LCratio after lobar resection was 0.76 ± 0.2. One-year survival in the ddL LTxgroup ranged from 50%-100%, compared to 72%-88%in the conventional-LTx group. In the largest study ddL LTx(n = 138) was associated with a lower one-year-survival compared to conventional-LTx(n = 539)(65.1% vs84.1%, P < 0.001). CONCLUSION Further investigations of optimal donor-to-recipient size matching parameters for ddL LTx could improve outcomes of this important surgical option.

Comminuted olecranon fracture fixation with pre-contoured plate:Comparison of composite and cadaver bones

AIM: To determine whether use of a precontoured olecranon plate provides adequate fixation to withstand supraphysiologic force in a comminuted olecranon fracture model.METHODS: Five samples of fourth generation composite bones and five samples of fresh frozen human cadaveric left ulnae were utilized for this study. The cadaveric specimens underwent dual-energy X-ray absorptiometry(DEXA) scanning to quantify the bone quality. The composite and cadaveric bones were prepared by creating a comminuted olecranon fracture and fixed with a pre-contoured olecranon plate with locking screws. Construct stiffness and failure load were measured by subjecting specimens to cantilever bending moments until failure. Fracture site motion was measured with differential variable resistance transducer spanning the fracture. Statistical analysis was performed with two-tailed Mann-Whitney-U test with Monte Carlo Exact test.RESULTS: There was a significant difference in fixation stiffness and strength between the composite bones and human cadaver bones. Failure modes differed in cadaveric and composite specimens. The load to failure for the composite bones(n = 5) and human cadaver bones(n = 5) specimens were 10.67 nm(range 9.40-11.91 nm) and 13.05 nm(range 12.59-15.38 nm) respectively. This difference was statistically significant(P ? 0.007, 97% power). Median stiffness for composite bones and human cadaver bones specimens were 5.69 nm/mm(range 4.69-6.80 nm/mm) and 7.55 nm/mm(range 6.31-7.72 nm/mm). There was a significant difference for stiffness(P ? 0.033, 79% power) between composite bones and cadaveric bones. No correlation was found between the DEXA results and stiffness. All cadaveric specimens withstood the physiologic load anticipated postoperatively. Catastrophic failure occurred in all composite specimens. All failures resulted from composite bone failure at the distal screw site and not hardware failure. There were no catastrophic fracture failures in the cadaveric specimens. Failure of 4/5 cadaveric specimens was defined when a fracture gap of 2 mm was observed, but 1/5 cadaveric specimens failed due to a failure of the triceps mechanism. All failures occurred at forces greater than that expected in postoperative period prior to healing.CONCLUSION: The pre-contoured olecranon plate provides adequate fixation to withstand physiologic force in a composite bone and cadaveric comminuted olecranon fracture model.

Role of the posterior deep deltoid ligament in ankle fracture stability: A biomechanical cadaver study

BACKGROUND The deltoid ligament is a key component of ankle fracture stability.Clinical tests to assess deltoid ligament injury have low specificity.In supination externalrotation(SER)type-IV ankle fractures,there is either a medial malleolus fracture or deltoid ligament injury.These injuries are often considered unstable,requiring surgical stabilisation.We look to identify the anatomical basis for this instability.This study investigates the anatomical basis for such instability by re-creating SER type ankle fractures in a standardised cadaveric study model,investigating the anatomical basis for such instability.AIM To investigate the anatomical basis for fracture instability in SER type ankle fractures.METHODS Four matched pairs of cadaveric limbs were tested for stability both when axially loaded and under external rotation stress.Four matched pairs of cadaveric limbs(8 specimens)were tested for stability when axially loaded to 750 N with a custom rig.Specimens were tested through increasing stages of SER injury in a stepwise fashion before restoring the lateral side with open reduction and internal fixation(ORIF).Clinical photographs and radiographs were recorded at each step.We defined instability in accordance with well accepted radiological parameters:>4 mm medial clear space opening on a mortise-view radiograph or>7 degrees of talar tilt.RESULTS All specimens with an intact posterior deep deltoid ligament were stable.Once the posterior deep deltoid ligament was sectioned there was instability in all specimens.Stabilisation of the lateral side prevented talar shift,but not talar tilt.CONCLUSION If the posterior deep deltoid ligament is intact then SER fractures can be managed without surgery.If the posterior deep deltoid is incompetent,ORIF and cautious rehabilitation is recommended because the talus can still tilt in the mortise.

A Questionnaire Survey in Kidney Transplant Outpatients: Factors Associated with Good Self-Management

It is very important for outpatients who have had a kidney transplant to take care of themselves after discharge. However, outpatients have limited access to medical care by hospital staff after discharge;therefore, medical staff are unaware of the patient’s living conditions, and the uncertainties and problems that they encounter related to self-management. We conducted a questionnaire survey among 161 of 200 outpatients who received kidney transplants to investigate their recognition and actual practice of daily self-management. To determine the characteristics of adherent outpatients, we divided patients into two groups (the adherent and non-adherent group) and compared them. The Chi-squared test was conducted to test the equality of proportions among the groups, and then multiple logistic regression analysis was used to explore the factors significantly associated with regularly taking medicine or failing to take medicine. As a result of the logistic regression model using demographic factors as independent factors, the periods after transplantation (2 - 5 and 5 - 10 years) and living-donor kidney transplantation or cadaveric kidney transplantation were selected as significant factors associated with good self-management. As a whole, 68.3% of the 145 patients were correctly predicted using the model. The results of this study suggest that in the short period after transplantation (2 - 5 years), cadaveric kidney transplantation and that the patient has a job are significant factors associated with good self-management. Behind these results, a unique Japanese concept, “amae”, could be found. Therefore, medical knowledge and techniques as well as cultural background should be studied.

Anatomic relationship of extensor indicis propius and extensor digitorum communis: Implications for tendon transfer

BACKGROUND The extensor indicis proprius(EIP)tendon is a frequently used donor for a variety of tendon transfers,most commonly for reconstruction of the extensor pollicis longus(EPL).EIP is known to have frequent anatomic variants including split tendons and variations in tendon arrangement.AIM To characterize the anatomy of the EIP at the level of the extensor retinaculum,where tendon harvest is often performed,and share our preferred technique for EIP to EPL transfer.METHODS Twenty-nine fresh-frozen cadaveric forearms without history of forearm or hand injury or surgery were dissected.Tendon circumference and relationship of the EIP and extensor digitorum communis to the index(EDCI)at the metacarpophalangeal(MCP)joint and the distal extensor retinaculum were recorded.Distance from the distal extensor retinaculum to the EIP myotendinous junction was measured.RESULTS EIP was ulnar to the EDCI in 96.5%of specimens(28/29)at the distal edge of the extensor retinaculum.In the remaining specimen,EIP was volar to EDCI.Tendon circumference at the distal extensor retinaculum averaged(9.3 mm±1.7 mm)for EDCI and 11.1 mm(±2.7 mm)for EIP(P=0.0010).The tendon circumference at the index MCP joint averaged 11.0 mm(±1.7 mm)for EDCI and 10.6 mm(±2.1 mm)for EIP(P=0.33).EIP had a greater circumference in 76%(22/29)of specimens at the distal extensor retinaculum whereas EIP had a greater circumference in only 31%(9/29)of specimens at the MCP joint.CONCLUSION The EIP tendon is frequently ulnar to and greater in circumference than the EDCI at the distal extensor retinaculum,which can be taken into consideration for tendon transfers involving EIP.

Comparison of two surgical approaches for petroclinic lesions

Objective:to compare the methods of petrous apical bone removal and to explore the applicable scope of Kawase approach and retrosigmoid sinus-internal auditory canal approach.Methods:one group of cadaveric head specimens simulated Kawase approach to measure the data of“Kawase triangle”,the other group simulated retrosigmoid sinus-internal auditory canal approach to measure the safety range of the grinding bone window.Then we explored the clinical indications of the two surgical approaches.Result:the grinding depth of Kawase triangle was 11.6±0.14 mm,and the range of clival exposed after grinding Kawase triangle was 22.4±1.22 mm,which could effectively expose the ventrolateral brainstem,the midline of clivus and the area above the facial acoustic nerve.The diameter of the anterior and posterior of the grinding bone window in the retrosigmoid sinus-internal auditory canal approach was 21.95±2.23 mm.In front of the exposure area were the internal carotid artery,the cavernous sinus,and the upper trigeminal nerve;the lower part was the connection between the facial acoustic nerve and the abducent nerve.Conclusion:Kawase approach is suitable for lesions of ventrolateral brainstem,middle superior clivus,with or without invasion of middle cranial fossa;the retrosigmoid sinus-superior internal auditory canal approach is suitable for lesions mainly in cerebellopontine angle area and only slightly invading Meckel’s cavity.

A Modified Shannon Trap for Use in Forensic Entomology

The objective of this study was to determine the efficacy of a modified Shannon trap to capture adult insects that are involved in cadaveric decomposition processes. The Shannon trap proposed here is composed of a thin fabric tent with a top formed by a transparent bottle containing a compartment filled with alcohol gel on which the captured insects are affixed. The trap was effective both for weather resistance and the quantity, quality and diversity of insects caught.

Can the rat donor liver tolerate prolonged warm ischemia?

INTRODUCTIONThe last two decades of the twentieth century havewitnessed increasingly successful rates of livertransplantation.The number of liver transplantations hasincreased steadily while the number of organ donors

Comparison of viscoelasticity between normal human sciatic nerve and amniotic membrane

Sciatic nerve tissue was obtained from the gluteus maximus muscle segment of normal human cadavers and amniotic membrane tissue was obtained from healthy human puerperant placentas. Both tissues were analyzed for their stress relaxation and creep properties to determine suitability for transplantation applications. Human amniotic membrane and sciatic nerve tissues had similar tendencies for stress relaxation and creep properties. The stress value of the amniotic membrane stress relaxation group decreased to a greater extent compared with the sciatic nerve stress relaxation group. Similarly, the stress value of the amniotic membrane creep group increased to a greater extent compared with the sciatic nerve creep group. The stress relaxation curve for human amniotic membrane and sciatic nerve showed a logarithm correlation, while the creep curve showed an exponential correlation. These data indicate that amniotic membrane tissue has better stress relaxation and creep properties compared with sciatic nerve tissue.

Olecranon anatomy:Use of a novel proximal interlocking screw for intramedullary nailing,a cadaver study

AIM: To define the optimum safe angle of use for an eccentrically aligned proximal interlocking screw(PIS) for intramedullary nailing(IMN).METHODS: Thirty-six dry cadaver ulnas were split into two equal pieces sagitally. The following points were identified for each ulna: the deepest point of the incisura olecrani(A), the point where perpendicular lines from A and the ideal IMN entry point(D) are intersected(C) and a point at 3.5 mm(2 mm safety distance from articular surface + 1.5 mm radius of PIS) posterior from point A(B). We calculated the angle of screws inserted from point D through to point B in relation to D-C and B-C. In addition, an eccentrically aligned screw was inserted at a standard 20° through the anterior cortex of the ulna in each bone and the articular surface wasobserved macroscopically for any damage.RESULTS: The mean A-C distance was 9.6 mm(mean ± SD, 9.600 ± 0.763 mm), A-B distance was 3.5 mm, C-D distance was 12.500 mm(12.500 ± 1.371 mm) and the mean angle was 25.9°(25.9°± 2.0°). Lack of articular damage was confirmed macroscopically in all bones after the 20.0° eccentrically aligned screws were inserted. Intramedullary nail fixation systems have well known biological and biomechanical advantages for osteosynthesis. However, as well as these well-known advantages, IMN fixation of the ulna has some limitations. Some important limitations are related to the proximal interlocking of the ulna nail. The location of the PIS itself limits the indications for which intramedullary systems can be selected as an implant for the ulna. The new PIS design, where the PIS is aligned 20°eccentrically to the nail body, allows fixing of fractures even at the level of the olecranon without disturbing the joint. It also allows the eccentrically aligned screw to be inserted in any direction except through the proximal radio-ulnar joint. Taking into consideration our results, we now use a 20° eccentrically aligned PIS for all ulnas. In our results, the angle required to insert the PIS was less than 20° for only one bone. However, 0.7° difference corresponds to placement of the screw only 0.2 mm closer to the articular surface. As we assume 2.0 mm to be a safe distance, a placement of the screw 0.2 mm closer to the articular surface may not produce any clinical symptoms.CONCLUSION: The new PIS may give us the opportunity to interlock IMN without articular damage and confirmation by fluoroscopy if the nail is manufactured with a PIS aligned at a 20.0° fixed angle in relation to the IMN.

Thiel-embalming technique:investigation of possible modification in embalming tissue as evaluation model for radiofrequency ablation

Contrary to freezing preservation and formalin embalming,Thiel embalmed cadaver presents soft texture and color very close to that of living organism,and many applications based on Thiel embalmed cadavers have been reported.However,Thiel embalmed cadavers cannot be used as reliable evaluation model for radiofrequency ablation(RFA)due to dramatic changes of electrical conductivity in the embalmed tissue.To address this issue,we investigated various modifications of the original Thiel embalming solution.By altering the chemicals' species and concentration we figured out a formula that can greatly reduce the embalming fluid's electrical conductivity without significantly compromising the 18-day embalmed kidney samples' suppleness and color.We also investigated a two-stage embalming technique by first submerging the kidney sample into original Thiel's tank fluid for 28 days,then the sample was withdrawn from the tank fluid and placed into modified dilution fluids for additional two weeks.Stiffening and discoloration occurred in these diluted samples implying the reversibility of Thiel-embalmed tissues' suppleness and color with the removal of the strong electrolytes.This study presents a modified embalming method which could be used for RPA evaluation and also helps our understanding of the mechanism of embalmment process.

Bacterial flora of conjunctiva after death

AIM:To evaluate the frequency of bacterial flora of conjunctiva after death(cadaver eyes) which will give information about the bacterial contamination of donor eyes,and the in-vitro sensitivity of isolated bacteria to the commonly used antibiotics in ophthalmic practice.METHODS:Conjunctival swabs were taken from the cadavers(motor vehicle accident deaths and patients who died in the hospital),within 6h after death,and sent for culture and sensitivity test.Conjunctival swabs,taken from the healthy conjunctiva of patients admitted for cataract surgery,were sent for culture and sensitivity as controls(eyes in those of living status).The bacterial isolates were tested against the commonly used antibiotics(chloramphenicol,gentamicin,ciprofloxacin) in ophthalmology practice.RESULTS:Bacteria were isolated in 41 out of 100 conjunctival swabs(41%),taken from 50 cadavers(study group).Coagulase negative staphylococcus was the most common bacteria isolated(15%),followed by pseudomonas aeruginosa(5%).Gentamicin was effective against majority of the bacterial isolates(82%).Bacteria were isolated from 7 out of 100 conjunctival swabs taken as control group(eyes in living state).Coagulase negative staphylococcus was the most common organism(5%) isolated in control group;the others were staphylococcus aureus(1%) and beta hemolyticus streptococci(1%).CONCLUSION:Bacteria were isolated from 41% of the cadaver eyes.High percentage sensitivity of the bacterial isolates to gentamicin(82%) supports the practice of thorough irrigation of the eyes with gentamicin solution before starting the procedure of enucleation followed by immersion of the enucleated eyeballs in gentamycin solution,to prevent the bacterial contamination.