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[The preservation of the whole corpse with natural color].

An especially low-odor embalming technique was developed over a 30-years-period using a total of 977 complete cadavers, numerous cadavers after autopsy, and in vitro series of fresh beef. The color, consistency, and transparency of the tissue were very well preserved. The technique met high standards of preservation without releasing harmful substances into the environment. Concentrations of formaldehyde in room air remained under the limit of detection by Dräger capillaries. The efficacy for disinfection of the method was confirmed by bacteriologic tests. None of the cadavers or samples developed molds.

Animals

Preparation of veterinary gross anatomy specimens: a method that allows storage at room temperature for four years.

On the basis of methods used to prepare human anatomic specimens, 2 Yucatan miniature pigs were embalmed over 4 years ago. Results obtained suggest that specimens commonly used in the teaching of veterinary gross anatomy may be fixed in this manner. Advantages include no requirement for refrigeration, superior long-term preservation, less offensive odor, and better tissue texture qualities, including less evidence of dehydration.

Anatomy, Veterinary

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

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

Anomalous origins of colic arteries.

The topography of the celiac trunk and superior and inferior mesenteric arteries was studied by dissection in 27 embalmed cadavers. Variant vascular patterns were noted in four subjects. These consisted of: (1) an accessory right hepatic artery from the superior mesenteric artery, (2) an anomalous middle colic artery from the proximal segment of the splenic artery, and (3) two instances of an accessory left colic artery originating from the superior mesenteric artery. The precarious course of the middle colic artery (coming from the splenic artery) and its dominance in the formation of the marginal artery were thought to predispose the ascending and transverse colon to an increased risk of vascular damage. These cases also illustrate two variant patterns of formation of the marginal artery. In the case of the anomalous middle colic artery, the only contribution of the superior mesenteric artery to the marginal artery was through the anastomosis of its ileocolic branch with the right branch of the aberrant middle colic artery. In subjects with accessory left colic arteries, the superior mesenteric artery played a dominant role in the formation of the marginal artery by contributing the accessory left colic artery, which supplied the splenic flexure and the proximal part of the descending colon. These arterial variations underscore the importance of doing vascular studies prior to major abdominal surgery.

Arteries

Three years of experience with a dissection table ventilation system.

A dissection table ventilation system that draws air across the cadaver and away from the table top was designed to fit the Shandon-Lipshaw AN-52 dissection table. Each U-shaped unit consists of a pair of hollow collection arms that attach to a collecting manifold at one end. During dissection the manifold is coupled to a central ventilation system through a flexible duct. The air from the table ventilation system is exhausted after passing through a heat recovery system. The unit is raised from the table surface during dissection of the body cavities to increase the efficiency of fume/odor removal. Eight hour exposure data for formaldehyde concentrations are presented. Data were collected from detectors positioned at selected levels above the cadaver during dissection, and above a tray on the table top containing a known volume of 4% formaldehyde or the West Virginia School of Osteopathic Medicine embalming fluid under varying airflow conditions. The results demonstrate that the table ventilation system is effective in reducing exposure to formaldehyde in the dissection laboratory.

Autopsy

Effect of femoral stem length on stress raisers associated with revision hip arthroplasty.

The objective of this study was to experimentally determine the optimal length of a femoral component in revision total hip arthroplasty (THA). Embalmed cadaveric femurs were loaded in a physiologic manner, and strains on the lateral cortex were measured. Two kinds of defects were tested to simulate THA after removal of a nail plate and after removal of a loose femoral stem. A drill hole was made in the lateral cortex of the femur to simulate the removal of a nail plate. A reaming defect was made, using flexible reamers to thin the cortex from the lesser trochanter distally to a site corresponding to the tip of a standard femoral component, to simulate THA after removal of a previously inserted femoral stem. Femurs were tested intact, with the defects, and after insertion of femoral components with stem lengths of 100 to 250 mm. The strain increased with the creation of a defect and decreased with the insertion of an implant. For a femur with a defect, the strain was minimized when the stem length extended 1.5 femoral diameters past the defect.

Alloys

The inferior thyroid veins--the ultimate guardians of the trachea.

The inferior thyroid veins and their multiple tributaries are the ultimate guardians of the cervical trachea. Deeply embedded in the pretracheal fat pad, this plexus of veins is consistently encountered during low tracheostomy that accompanies conservation laryngral procedures as well as in tracheal reconstruction. In a high tracheotomy, the handling of the thyroid isthmus is simplified by an appreciation of these veins. Even cricothyrotomy is potentially complicated by hemorrhage sebsequent to a tear in a tributary of the inferior thyroid venous system. A cadaver study, employing 10 embalmed head and neck specimens, was performed to elucidate the tributary patterns of these veins. In every dissection there was at least one and as many as five veins overlying the trachea just below the thyroid isthmus. In 7 of 10 dissections a confluence of right and left inferior thyroid veins formed a large thyroid ima vein draining into the left innominate vein, and in 1 of 10 cases the thyroid ima vein drained into the right innominate. This confluence was present at a level which would be encountered in low tracheostomy or tracheal repair procedures. Six of 10 dissections presented large tributaries of the inferior thyroid veins overlying the cricothyroid membrane. An awareness of such anatomical considerations should result in safer surgical procedure performed in a dry operative field.

Humans

Paleoradiologic evaluation of the Egyptian royal mummies.

We examined radiographs of 12 Egyptian royal mummies obtained by two of the authors (W.R. and J.E.H.) and never before published. These radiographs demonstrate findings not previously described in Egyptian mummies, including congenital lunate-triquetral fusion and destructive skeletal lesions not explainable on the basis of vandalism by tomb robbers. Antemortem fractures, degenerative joint disease, and arterial vascular calcification were also seen. In 11 of the 12 cases, there was chondrocalcinosis of intervertebral discs or menisci, probably an artifact of embalming. Visceral packing and skeletal deformity due to wrapping were observed, as well. Radiology provides important paleopathologic and archeologic information for the accurate, comprehensive study of Egyptian mummies.

Bone Diseases

The fibrous frame of the supraspinatus muscle. Correlations between anatomy and MRI findings.

30 MRI investigations of shoulders and 20 dissections of non embalmed cadaveric shoulders allowed us to demonstrate a particular organization of the supraspinatus muscle. In the anterior part of the muscle is an important fibrous frame with obliquely inserted muscle fibers. This organization suggests that this part of the supraspinatus muscle works as a "contractile tendon".

Humans

Direct anatomical-MRI correlation: the knee.

Cadaveric material is often used to guide and validate the interpretation of magnetic resonance imaging (MRI) studies. Direct correlation is achieved when the cadaver material is imaged and then directly sectioned in the plane of the image. Indirect correlation, where the cadaveric sections are compared with unrelated in-vivo images, is easier and more commonly used. Technical difficulties associated with the direct method include preservation of form and composition of the tissues, and the choice of the correct location and plane in which to section the cadaver. Using an MRI compatible ruler, designed to assist the direct correlation of MRI and cadaveric sections, we have examined 10 preserved (embalmed) cadaveric knees using different MRI sequences on several occasions. Despite these variations, subsequent sectioning of the cadaveric knees has shown good correlation with the MR images. Of 54 MR images compared with cadaveric sections, anatomical correlation was rated by independent observers as good or perfect in 47 (87%). This new, versatile and simple method can make better use of our preserved human cadaveric material and has potentially wide application; we are now developing it further to assess the technical capabilities of novel imaging sequences.

Aged

The surgical anatomy of the superior gluteal nerve and anatomical radiologic bases of the direct lateral approach to the hip.

In view of the increasing popularity of the direct lateral approach to the hip joint for hemi- or total hip arthroplasty, the location of the superior gluteal nerve (SGN) was studied. This nerve is in danger when using a transgluteal incision. In 20 embalmed specimens the relation of the SGN to the tip of the greater trochanter (TT) was studied as well as the relation to the iliac crest. For this purpose macroscopy, microscopy and CT were used. In 13 hips a so-called most inferior branch was found at an average of 1 cm distal to the inferior branch, the main trunk of the nerve. There was substantial variation in the course of both the inferior and the most inferior branch of the SGN. In order to prevent nerve damage, proximal extension of the transgluteal incision should be limited to 3 cm cranial to TT. Furthermore the incision has to be confined to the distal one third of the distance TT-iliac crest. In tall people extra care should be taken.

Aged