Cadaver Group Research Articles

Elastic fibers in the anterior abdominal wall

The aim of this study was to substantiate the hypothesis as to whether an altered amount of elastic fibers in the linea alba aponeurosis occurs or not in anterior abdominal wall hernias (epigastric, incisional and umbilical), comparing the findings with those of a control group of cadavers without hernias. Thirty patients (15 males and 15 females) with anterior abdominal wall hernias were evaluated for analysis of the elastin content in samples from the linea alba aponeurosis, with immunohistochemistry and orcein staining using videomorphometry. The results showed a greater amount of elastin in patients with abdominal wall hernias compared to the control group of cadavers without hernias (P < 0.05). The elastic fibers were greatly thickened, tortuous and fragmented in the patients. It is essential to analyze the anterior abdominal wall concerning its anatomical condition and histological components. Altered collagen and elastic fibers play an important role in hernia formation, indicating that the main factor may be biological.

Chest Tube Placement in Gross Anatomy Lab

OPEN ACCESSNovember 30, 2009Chest Tube Placement in Gross Anatomy Lab Katrina Wade, MD, FAAEM, FAAP, Margaret Cooper, PhD, Vijai Chauhan, MD Katrina Wade, MD, FAAEM, FAAP Saint Louis University School of Medicine Google Scholar More articles by this author , Margaret Cooper, PhD St. Louis University School of Medicine Google Scholar More articles by this author , Vijai Chauhan, MD St. Louis University School of Medicine Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.7722 SectionsAboutAbstract ToolsDownload Citations ShareFacebookTwitterEmail AbstractAbstract Introduction: In the first of a series of teaching modules incorporating the knowledge of gross anatomy into various clinical procedures, first-year medical students were taught how to place a chest tube in their cadavers while learning about and dissecting the pectoral region, thoracic wall cavity, in a human anatomy course. Methods: Each cadaver group of three to five students had a preceptor assigned. Equipment included scalpels, as well as donated expired chest tubes and Kelly clamps. Prior to the lab session, students received an introduction/description of the module with goals/objectives and were required to watch a video narrated by a faculty member showing a second-year medical student performing the procedure on a cadaver. Students were also given a one-page handout showing the landmarks, equipment needed, indications, and complications for tube thoracostomy. Following the session, evaluations were submitted by the medical students. Results: Feedback from faculty and students indicated that we had met and exceeded our educational objectives. Students felt that the procedure was “relevant,” liked the “stress free” environment featuring early clinical experience with supervision in small groups, and looked forward to more such experiences during the course. They enjoyed practicing the procedure on a cadaver before doing so on a live patient, noting that the experience would help boost their confidence they could do the procedure later without hurting the patient. Faculty felt that the students were motivated by the session and sought out more educational resources related to the procedure. Discussion: The trend for medical education is to integrate basic science, clinical science, and research in a curriculum that fosters an active learning environment. Medical education is a lifelong continuum that requires self-directed learning. By introducing clinical science early on, enthusiasm for learning is stimulated, and the experience gives students some of the skills required for critical thinking. Using an organ-based model helps students to better understand the relevance of a solid basic science foundation in clinical application. It also creates an effective teaching tool that allows basic science faculty and clinical science faculty to collaborate. This course model is a relatively inexpensive yet very effective teaching method that will enhance the training of medical students and future house officers. It can be easily reproduced and addresses areas of the core competencies required of accredited U.S. residency training programs set by the Accreditation Council for Graduate Medical Education. Educational Objectives By the end of this session, learners will be able to: Gain an early introduction to procedural skills in order to enhance confidence and performance of chest tube placement by house staff.Collect information that demonstrates the relevance of anatomical knowledge in order to understand the benefits, risks, and complications of chest tube placement.Integrate clinical medicine during the basic science years.Recognize the concepts of learning procedures in a simulation setting.Familiarize themselves with resuscitative skills needed in emergency medicine, surgery, and critical care rotations.Reduce medical errors in procedures done as outlined by the Institute of Medicine Reports in 1999 and 2001.Experience small-group hands-on faculty instruction in a controlled setting. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Description.pdf Evaluation.pdf Syllabus.pdf VIDEO_TS Folder To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. This publication includes large downloadable files. If you experience difficulty downloading these files, please contact [email protected] to receive a free DVD version via mail. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. Copyright & Permissions© 2009 Wade et al. This is an open-access article distributed under the terms of the Creative Commons Attribution license.KeywordsChest TubesCadaverThoracostomy Disclosures None to report. Funding/Support None to report. Loading ...

Digital image analysis of fingernail colour in cadavers comparing carbon monoxide poisoning to controls

Carbon monoxide is a component of motor vehicle exhaust fumes, provided a functional catalytic converter is not present. This gas binds avidly to the hemoglobin molecule in red blood cells preventing its oxygen transport function, effectively poisoning the body by starving it of oxygen. In binding to hemoglobin, carbon monoxide forms carboxyhemoglobin, which has a characteristic bright pink color. It has been remarked that the fingernails of victims of carbon monoxide tend to exhibit pink color, otherwise fingernails of deceased bodies tend towards a dark red to blue color. This study sought to objectively determine by using digital image analysis if a color difference occurred between the fingernails of a group of cadavers with carbon monoxide poisoning compared to a group of controls. The fingernails of the carbon monoxide group did tend to be more red than the controls, but due to overlap between the two groups assessment of the fingernails cannot be recommended as a rapid screening test.

Evaluation of Cadaveric Renal Vein Lengths and Their Extension Loss with Three Types of Ligature and Section

The right kidney has been less frequently used in live donor nephrectomy, because of the shorter length of the right renal vein (RRV) that is associated with technical difficulties and higher rates of venous thrombosis. In live open donor or deceased donor transplant nephrectomy, an additional cuff of the inferior vena cava is usually removed, but this is a more difficult and risky maneuver in laparoscopic nephrectomy. For this reason, laparoscopic right nephrectomy (LRN) for renal transplantation (RT) is not frequently performed in most medical institutions. We evaluate the difference between RRV and left renal vein (LRV) lengths in cadavers, as harvested for RT by three clamping methods. Our objective was to obtain information that could clarify when LRN for RT should be encouraged or avoided with regard to conventional surgery. Ninety adult fresh unfrozen cadavers were randomly divided into three groups of 30, according to the clamping device used: Satinsky, stapler, and Hem-o-lok clip. The abdominal viscera were removed through a median xyphopubic incision, and the veins were measured on the bench. Two lateral limits were used: The renal hilum and the tangential line of the renal poles. As for medial limits, the inferior vena cava or the laparoscopic clipping device on the RRV were used on the right side, while on the LRV, the medial border of the emergence of the adrenal vein was considered. After section of the renal vein, a slight traction of the extremity was applied for the measurement. All measurements were obtained three times using a metallic millimetric ruler, and the arithmetic mean was considered. The chi-square, one-way analysis of variance, and paired t tests were used for statistical analysis. Statistical significance was accepted at P <or= 0.05. The groups of cadavers were homogeneous in demographic characteristics. Regardless of the clamping method and considering the useful length of the LRV, the RRV was statistically smaller. The evaluation of the vein length did not depend on the lateral limit considered. Independent of the clamping method, on both sides, the lengths after the vein section were larger than before the section, a fact attributed to traction. Use of a stapler and a single Hem-o-lok presented the same waste of vein length on the right side. On average, the RRV was 13.7% shorter than the LRV. With the wide acceptance of laparoscopic live donor nephrectomy, the length difference between the veins of both kidneys is an important issue, and the right kidney is therefore used less than the left, compared with conventional surgery. This article represents the first step to quantify the anatomic length of renal veins in different situations. Certainly, more imagenologic or surgical studies should be carried out before decisions can be made for better selection of patients for LRN.

Thumb Interphalangeal Joint Extension By the Extensor Pollicis Brevis: Association With a Subcompartment and de Quervain's Disease

First dorsal compartment anatomy was analyzed for the presence of a separate compartment for the extensor pollicis brevis (EPB) tendon and the ability of the EPB to extend the thumb interphalangeal (IP) joint in order to determine if these characteristics were associated with each other, and with de Quervain's disease. Two groups were studied: (1) 90 cadaver wrists, 28 to 89 years, 38 male and 52 female specimens; and (2) 143 patient wrists, 21 to 82 years, 18 men and 125 women, in which the first dorsal compartment was released for treatment of de Quervain's disease. The EPB was in a separate compartment in 102 of 143 of the surgical group and 18 of 90 of the cadaver group. The EPB was able to extend the IP joint in 56 of 143 of the surgical group and 19 of 90 of the cadaver group. When the EPB was able to extend the IP joint, it was in a subcompartment in 49 of 56 of the surgical group and 9 of 19 of the cadaver group. When the EPB was able to produce IP extension in the cadaver group, it was inserted on the distal phalanx or the extensor hood. In a substantial number of people undergoing surgery for de Quervain's disease and in cadavers, the EPB can extend the thumb IP joint. When it does, particularly in patients with de Quervain's disease, it is likely to reside in a subcompartment of the first dorsal compartment. The incidences of a subcompartment for the EPB and the ability of the EPB to extend the thumb IP joint were higher in the de Quervain's patient population than in the cadaver group.

Peritoneal surface area: measurements of 40 structures covered by peritoneum: correlation between total peritoneal surface area and the surface calculated by formulas

We have not found studies that have measured the peritoneal surface area of each of the walls, organs, mesos, omenta, and peritoneal ligaments in a group of non-eviscerated human cadavers. The objectives of this study were to obtain in fixed non-eviscerated cadavers: (1) the surface values of walls, organs, mesos, omenta, and peritoneal ligaments of each one and all the areas mentioned in the anatomy bibliography and their contribution to supra- and infra-colic portions, visceral and parietal portions of the supra- and infra-colic portions and the total peritoneal surface area, and (2) the relationship between the peritoneal surface values by direct measurement and the values obtained applying the formulas usually used in clinical practice to obtain body surface area. The peritoneal surface area of ten female human bodies presenting no abdominal pathologies were measured. They were fixed in 5% formaldehyde solution without the use of perfusion pumps and non-eviscerated, thus maintaining all structures intact. Cellophane was placed directly in situ onto all organs, mesos, omenta, ligaments and parietal walls. Digital imaging was obtained by scanning the models. A length reference was included and the surface was determined by the Scion Image program for Windows. This paper provides for the first time data on each one and all the areas covered by the peritoneum. The total peritoneal surface area was (mean +/- SE) 14,323.62 +/- 824.37 cm(2). The two greater surfaces of peritoneum (39.21% of the total surface) correspond to the jejunum-ileum and its mesentery. The diaphragmatic peritoneum represented the greater area of parietal peritoneum. The supracolic surface was 4,487.46 +/- 196.21 cm(2) (31.79 +/- 1.50%) and the infracolic one of 9,836.16 +/- 732.67 cm(2) (68.21 +/- 1.50%). An interesting result of this work is that the surface of the parietal peritoneum in the supracolic abdomen (1,786.67 +/- 92.58 cm(2), 68.56%) is more than twice that of the infracolic region (756.62 +/- 55.91 cm(2), 31.44%). The visceral peritoneal surface (81.89 +/- 0.99% of the total) was much higher than that of the parietal peritoneum (18.11 +/- 0.99%). This difference is 12 times bigger in the infracolic abdomen. The peritoneal surface area measured in this study in non-eviscerated cadavers represents more than 96% of the one estimated by the above-mentioned formulas. The values shown in this paper would provide non-existing information for basic anatomy, and would contribute either to the study of pathologies involving the peritoneum or to their diagnosis and therapies.

Evaluation of Facial Allograft Transplantation in Humans in a Cadaver

Evaluation of Facial Allograft Transplantation in Humans in a Cadaver

Biceps Insertion Distance Influences Elbow Flexor Isometric Force at 900 Joint Angle

Lever arm distances significantly affect the external force that can be generated by flexing a limb (Nordin & Frankel, Basic Biomechanics of the Musculoskeletal System, 2001), but this effect is seldom considered in strength testing. PURPOSE To examine variability in the distance from the insertion of the biceps brachii to the elbow joint and its effect on elbow flexor isometric strength score. METHODS We measured the distance (DB) from the radial insertion of the biceps brachii to the center of the axis of rotation of the elbow joint directly in 8 cadavers (CAD), and in 54 subjects using magnetic resonance imaging (MRI). DB estimated from height (DBest) was used to calculate peak true force of the elbow flexors in a test that measured external force transmitted by the wrist pressing against a padded force detector, fixed at 28 cm from the elbow joint, during maximal isometric contraction of the elbow flexors at a joint angle = 90° in 700 subjects. RESULTS Actual DB varied from 3.8 to 7.5 cm. Standing body height predicted DB in both the MRI and cadaver groups: Height was used to estimate DBest in the 700 subjects, whose height ranged from 52.8 to 76.8 inches. Based on height, DBest ranged from 4.1 cm to 7.1 cm. Biomechanically, the elbow joint and forearm function as a third class lever: in subjects with a greater DB, the same elbow flexor force (true force) generates a greater measured external force at the wrist. Thus elbow flexor force measured at the wrist 28 cm from the elbow, was found to overestimate true flexor force by 10% per 4 inches of height. CONCLUSIONS The findings illustrate the mechanical advantage afforded by height, expressed through DBest, on a common strength test in which force is measured at the wrist. For adult subjects who vary in height, investigators can use body height to estimate DBest to obtain true force of the elbow flexors on an isometric force test when the elbow angle is 90°.

Biochemical analysis and immunohistochemical determination of cardiac troponin for the postmortem diagnosis of myocardial damage.

Cardiac disease is the most common cause of sudden death in Western nations. In forensic practice there is a need for more sensitive diagnostic methods for the postmortem diagnosis of myocardial damage. The aim of this study was to analyse the diagnostic efficacy of biochemical markers in cadaver fluids in conjunction with histological studies and the immunohistochemical determination of cardiac troponin C (cTnC) and cardiac troponin T (cTnT) levels in myocardial tissue fixed in formol and included in paraffin. We studied 50 cadavers (43 males and 7 females) with a mean age of 47.5 years (SD 19.2; range 12 to 87 years). Cases were chosen according to the postmortem interval, cause of death, and circumstances of death. Pericardial fluid and serum were tested in duplicate for cardiac troponin I (cTn I), myoglobin and CKMB by immunoassay system using commercial kits. In myocardial tissue, histological studies were performed with hematoxylin and eosin (HE), Masson's trichrome staining and immunohistochemical techniques involving streptavidin-biotin-peroxidase were performed. The results pointed to statistically significant differences for all the biochemical markers in pericardial fluid. The highest levels were obtained in the group of cadavers who had died from myocardial infarction. The immunohistochemical expression of cTnC was detected in 86% of cases; it was strongly positive and usually diffuse. The expression of cTnT, was much less frequent (46% of cases) and less intense. It was concluded that the immunohistochemical determination of cTnC and cTnT levels in myocardial tissue may be used as an index of myocardium damage.

Improving laparoscopy in embalmed cadavers: a new method with a lateral abdominal wall muscle section

Rigor mortis can be a problem when laparoscopy is performed in embalmed cadavers for surgical training. To improve the laparoscopic view, a new technique for managing the abdominal wall with a cutaneous-subcutaneous flap, pneumoperitoneum (14-15 mmHg), and a progressive (step-by-step) bilateral section of the lateral muscles of the abdomen was attempted in 10 embalmed cadavers. The degree of abdominal wall increase was calculated by measuring changes in the size of the abdominal wall after each step. Improvement in the peritoneal laparoscopic view was also assessed. For abdominal wall size, no constant relationship was observed between initial (after creation of the pneumoperitoneum) and final increment (after each muscular layer section). Cumulative degrees of increase in the dimensions of the abdominal wall were the only parameters that showed a significant difference among the four groups of cadavers. Bilateral sectioning of both oblique muscles was sufficient to obtain an adequate view of the abdominopelvic cavity; thus, the risk of an unexpected peritoneal opening during sectioning of the transversum abdominis muscle was obviated. In embalmed cadavers, the laparoscopic view in the presence of a pneumoperitoneum can be facilitated by a section of the lateral muscles of the abdomen, with a previous cutaneous-subcutaneous flap. To obviate an incidental opening of the peritoneum, resulting in air leakage, preservation of the deep muscular layer is advisable.

Right hemiliver transplants from cadavers or living donors: a comparative analysis

IntroductionThe aim of this article was to compare the results of right hemiliver transplants from living versus cadaver donors in a single institution. MethodsBetween March 1999 and May 2003, we performed 10 right hemiliver transplants from living donors (LD) and 8 right hemiliver transplants from cadavers (CD). The procedure consisted of grafting liver segments 5, 6, 7, and 8. The procedure was performed with a fully perfused liver also in the CD group (in situ split). ResultsWith follow-up between 7 days and 26 months in the LD group, 2 patients died with functioning grafts: 1 patient died because of massive pulmonary bleeding due to Rendu-Osler Syndrome; the other one died as a consequence of systemic aspergillosis. One patient underwent retransplantation due to arterial thrombosis. In the CD group with a follow-up between 31 days and 48 months, 3 patients died due to sepsis, including 2 who were status 2A. There were 4 early complications among the LD group and 5 in the CD group. The patient and graft survival rates were 80% and 70%, respectively, in the LD group; and both about 62% in the CD group. ConclusionRight hemiliver grafts are at high risk due to technical and septic complications. A higher morbidity is observed in the CD group, where the vascular and biliary tree anatomy cannot be investigated with accuracy. We must avoid transplanting status 2A recipients with this kind of graft.

Diagnostic efficacy of biochemical markers in diagnosis post-mortem of ischaemic heart disease

In forensic medicine, there is a need for more sensitive biochemical markers for the post-mortem diagnosis of acute myocardial infarction. A study of the distribution of biochemical markers in different fluids is of great significance in post-mortem diagnosis, because their distribution depends on the location of tissue damage and release kinetics. The aim of this study is to compare the sensitivities and specificities of creatine kinase-MB (CK-MB), myoglobin and cTnI in serum and pericardial fluid for the post-mortem diagnosis of acute myocardial infarction (AMI). We studied 188 cadavers selected during 1 year from medicolegal autopsies. The groups were as follows: (1) myocardial infarction ( n=52); (2) asphyxia ( n=59); (3) multiple trauma ( n=41); (4) natural deaths excluding myocardial infarction ( n=36). We obtained statistically significant differences in pericardial fluid for all the biochemical markers, the highest levels being obtained in the group of cadavers who had died from myocardial infarction. A common factor is the high negative predictive value found in biochemical markers, which is contrary to the findings obtained in clinical practice, when the percentages of sensitivity are very high.

Dermal dendritic cell number correlates with serum autoantibody titers in Brazilian pemphigus foliaceus patients

Pemphigus foliaceus (PF) is an autoimmune bullous disease endemic in Brazil. Since serum IL-12 is increased in patients with PF and Langerhans cells (LC) produce IL-12, we titrated serum autoantibodies by indirect immunofluorescence, and quantified epidermal dendritic cells, known as LC, and dermal dendritic cells (DC). Biopsies of blistering lesions were obtained from 22 patients, 13 of whom were submitted to biopsy of both injured and of apparently healthy skin. The control groups consisted of skin from 8 cadavers and from 12 women submitted to breast plastic surgery. LC and DC were identified with anti-CD1a antibody and quantified by morphometric analysis. LC number in the lesion and in apparently healthy skin from PF patients was similar to that of both control groups. DC number in the injured skin (median=0.94 DC/mm basement membrane) was higher than that of the cadaver group (median=0.13 DC/mm basement membrane). In the 13 patients with biopsies of both injured and apparently healthy skin, LC and DC were present in larger numbers in the lesion. There was a direct correlation between DC number in the lesion of the PF group and serum autoantibody titers. This correlation was not observed for LC number. The increased number of DC in the lesion, as well as its direct correlation with serum autoantibody titers suggest the participation of DC in the pathogenesis of PF. The relationship between increased DC number and IL-12 in PF needs to be clarified.

Donor Bone Marrow Infusion in Deceased and Living Donor Renal Transplantation

The infusion and persistence in a transplant recipient of donor-derived bone marrow cells (DBMC) of multi-lineage can lead to a state of permanent chimerism. In solid vascular organ transplantation, the donor bone marrow lineage cells can even be derived from the transplant organ, and these cells can be detected in very small numbers in the recipient. This has been called microchimerism. Much controversy has developed with respect to the function of chimeric cells in organ transplantation. One idea is that the occurrence of these donor cells found in microchimerism in the recipient are coincidental and have no long-term beneficial effect on engraftment. A second and opposing view, is that these donor cells have immunoregulatory function that affect both the acute and chronic phases of the recipient anti-donor responses. It follows that detecting quantitative changes in chimerism might serve as an indication of the donor-specific alloimmune or regulatory response that could occur in concert with or independent of other adaptive immune responses. The latter, including autoimmune native disease, need to be controlled in the transplant organ. The safety and immune tolerance potential of DBMC infusion with deceased and living donor renal transplants was evaluated in a non-randomized trial at this center and compared with non-infused controls given identical immunosuppression. Overall DBMC infusions were well tolerated by the recipients. There were no complications from the infusion(s), no episodes of graft-vs-host disease (GVHD) and no increase infections or other complications. In the deceased DBMC-kidney trial, actuarial graft survival at 5 years was superior especially when graft survival was censored for recipient death. Acute rejections were significant reduced in patients given two DBMC infusions, and chronic rejection was dramatically reduced in all DBMC treated patients. The most interesting finding was that the degree of microchimerism slowly increased over the years the DBMC group that had exhibited no rejection episodes. In the DBMC-living related trial, the incidence of acute rejection did not differ between groups. However, DBMC chimerism in recipient iliac crest marrow had increased more rapidly than might be predicted from results previously seen in the cadaver group, despite four times fewer DBMC infused, with the generation of T- regulartory cells in-vitro assays.

Tibial and talar trabecular lines in the assessment of ankle alignment

The measurement of talar alignment in patients with ankle destruction due to arthritis or previous surgery can be difficult when planning surgery. Radiographs were used to determine whether tibial and talar trabecular lianes are a reliable method of assessment. Trabecular orientation within the talus and distal tibia was measured using an electronic goniometer in standard mortise view anteroposterior (AP) ankle radiographs from 25 normal patients. Radiographs of 12 cadaver ankles were taken in AP, and in 15 and 30° of both internal and external rotation and the trabecular orientation similarly measured. Three independent clinicians assessed the radiographs on two separate occasions. In the normal group the mean trabecular angle was 0.5° valgus (95 percentile: 4° varus to 5° valgus). In the cadaver group of mortise AP radiographs the mean trabecular angle was 1.6° valgus (95 percentile: 4° varus to 10° valgus). Positioning cadaver ankles in internal or external rotation had little effect on the mean trabecular angle, but observer variation increased. Normal ankles consistently have a tibio-talar trabecular angle of between 5° varus and 5° valgus on good mortise view AP radiographs. Uncertainty of measurement increased with rotation or plantarflexion of the ankle. These lines can be used to determine the varus/valgus orientation of the talus within the ankle joint, which may be useful when assessing joints destroyed by disease or removed at surgery.

Effect of living-related donor bone marrow infusion on chimerism and in vitro immunoregulatory activity in kidney transplant recipients.

In a previously reported series of donor-specific bone marrow cell (DBMC) infusions in cadaver kidney transplant recipients, there appeared to be an improvement in long-term graft survival (6 years) and fewer chronic rejections, which correlated with increasing DBMC chimerism (approximately 1.4% in the iliac crest bone marrow compartment now at 6 years). Prompted by this, we embarked on a study of DBMC infusion in living-related donor (LRD) kidney transplant recipients. Between November 1996 and May 2000, 47 LRD kidney transplant recipients received donor iliac crest marrow (1.8 x 10(8)+/-1.9 x 10(8) cells/kg body weight+/-SD) in a single infusion 4 days postoperatively. Either OKT3 (n=26) or daclizumab (n=21) were used for induction therapy, with maintenance tacrolimus, mycophenolate mofetil, and methylprednisolone immunosuppression. These recipients were prospectively compared with 39 noninfused LRD kidney transplants (control group), which received equivalent immunosuppression in the same time period. Clinical follow-up ranged from 19.0 months to 61.6 months (mean 33.2 months). Polymerase chain reaction-flow chimerism analysis and in vitro assays of immunoregulatory activity of chimeric cells were performed. The incidence of acute rejection over this period of time was 10.6% and 10.3%, respectively (i.e., did not differ between groups). Immunosuppressive dosages were somewhat (but not statistically) lower over time in the DBMC group. Four-year actuarial patient and graft survival for the DBMC-infused group was 98% and 98%, and 98% and 95% for the control group, respectively ( =NS). DBMC infusion was well tolerated, with no increase in infectious episodes. DBMC chimerism in recipient iliac crest marrow has increased more rapidly than might be predicted from results previously seen in the cadaver group, despite four times fewer DBMC infused. DBMCs and (donor) peripheral blood mononuclear cells purified by immunobeads from recipient blood or bone marrow (recipient-derived donor cells) inhibited mixed leukocyte responses of the recipient to the donor more strongly than freshly obtained peripheral blood cells drawn from the donors or even compared with bone marrow cells aspirated from the donors in a previously reported group of experiments. Additionally, similarly purified recipient-derived recipient cells from the same chimeric recipient more strongly inhibited the same mixed leukocyte response reactions autologously than a large group of nonchimeric (autologous) bone marrow modulating cells in similar reactions. These observations confirm that an immunoregulatory process appears to have been generated by DBMC infusion, encouraging a further decrease in immunosuppressive dosing using such assays in the future.

Should we reevaluate the variables for predicting the difficult airway in anesthesiology?

Anesthesiologists have often been confronted with the difficult question of determining which patient will present an increased difficulty for endotracheal intubation. The limits of the previously reported morphometric airway measurements for predicting difficult intubation have inadequately addressed the normal patient population variables. We designed this prospective study to investigate the age and sex-related changes in the morphometric measurements of the airway in a large group of patients without anatomic abnormality and a group of cadavers. Hyomental, thyromental, sternomental distances, neck extension, and Mallampati scores were evaluated in 12 cadavers and in 334 patients. Patients were allocated to three groups based on age: Group 1 (20-30 yr), Group 2 (31-49 yr), and Group 3 (50-70 yr). Male and female sex differences were also evaluated. Hyomental distance was the only variable not affected by age. In addition, the mean population values were less than the threshold values suggested as criteria for difficult endotracheal intubation. All the other criteria were age-dependent and inversely affected by the increase in age. Male sex was also a distinction for increased measurements of all the morphometric distances. The mean degree of neck extension was similar in both sex groups. This study provides a more comprehensible approach to the morphometric measurements of the human airway. Adequate data of normal values may help the clinician to identify patients that are outside the range and therefore may be challenging. This study was performed to establish data on the average values of airway morphology in the adult population of different age groups and sex. Hyomental, thyromental, sternomental distances and neck extension values were measured on 12 cadavers and 334 patients.

Bronchial healing, lung parenchymal histology, and blood gases one month after transplantation of lungs topically cooled for 2 hours in the non–heart-beating cadaver

Background The aim of this study was to investigate, in an experimental survival model, the functional and morphologic results of lung transplantation using lungs from non–heart-beating donors. Methods Left lungs, topically cooled to 25° C for 2 hours in situ after 5 minutes of circulatory arrest followed by 26 minutes of unsuccessful cardiopulmonary resuscitation, were transplanted into syngeneic rats. Five weeks after the transplantation, right pneumonectomy was performed and blood gases measured after 60 minutes. In a control group, fresh donor lungs were used for transplantation and comparison was made with the cadaver group and a group of normal rats after right pneumonectomy. Morphologic changes were evaluated by semiquantitative scoring of 13 different parameters to obtain a total histologic index for each rat. Results Computerized tomography scans of the chest made during the third post-operative week showed normal lung parenchyma in both groups, and at 5 weeks there were no significant differences in blood gases. The bronchial anastomoses showed normal healing in all cases. The histologic changes in the lung parenchyma were generally mild and focal, primarily consisting of interstitial and perivascular mononuclear inflammation, bronchial inflammation and athelectasis. Surprisingly, the transplanted controls demonstrated the most pronounced changes, although only the difference in total histologic index between groups was significant. Conclusions Lungs from non–heart-beating donors, topically cooled in the cadaver for two hours after failed resuscitation, showed normal bronchial healing and favorable parenchymal histology compared to transplanted control lungs 5 weeks after transplantation.

Warm Ischemic Tolerance in Collapsed Pulmonary Grafts Is Limited to 1 Hour

To determine the length of warm ischemic tolerance in pulmonary grafts from non-heart-beating donors. If lungs could be retrieved for transplant after circulatory arrest, the shortage of donors might be significantly alleviated. Great concern, however, exists about the length of tolerable warm ischemia before cold preservation of pulmonary grafts retrieved from such non-heart-beating donors. The authors compared the influence of an increasing postmortem interval on graft function in an isolated, room air-ventilated rabbit lung model during blood reperfusion up to 4 hours. Four groups of cadavers (four animals per group) were studied. In group 1, lungs were immediately reperfused. In the other groups, cadavers with lungs deflated were left at room temperature for 1 hour (group 2), 2 hours (group 3), or 4 hours (group 4). Pulmonary vascular resistance was enhanced in all ischemic groups compared with the control group. An increase was noted with longer postmortem intervals in peak airway pressure and in weight gain. A concomitant decline was observed in the venoarterial oxygen pressure gradient caused by progressive edema formation, as reflected by the wet-to-dry weight ratio at the end of reperfusion. Warm ischemia resulted in increased pulmonary vascular resistance. Graft function in lungs retrieved 1 hour after death was not significantly worse than in nonischemic lungs. Therefore, 60 minutes of warm ischemia with the lung collapsed may be tolerated before cold storage. Further studies are necessary to investigate whether lungs retrieved from non-heart-beating donors will become a realistic alternative for transplant.

URETHRAL GRACILOPLASTY FOR TREATMENT OF FEMALE INTRINSIC SPHINCTER DEFICIENCY: RATIONALE FOR THE TRANSVAGINAL APPROACH: AN ANATOMICAL STUDY

Purpose To compare the retropubic and transvaginal approaches in terms of the length of gracilis muscle available for female urethral graciloplasty. Materials and Methods Two groups of female cadavers were submitted to bilateral gracilis muscle dissection, followed by urethral graciloplasty using either the standard retropubic approach or the transvaginal approach. The two groups were studied in terms of various muscle characteristics, in particular the length of muscle that could effectively be wrapped around the bladder neck. Results Because muscle transfer to the perineum was more direct, the transvaginal approach provided a greater functional length of gracilis for effective periurethral wrapping than the retropubic approach (mean: 8.4 cm. versus 5.2 cm., p = 0.0022). Conclusion The transvaginal approach allows a more “proximal” graciloplasty and should therefore be evaluated clinically to provide circumferential bladder neck support without tension.